Provider Demographics
NPI:1114040177
Name:LAIT, MEGAN HICKEY (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:HICKEY
Last Name:LAIT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 MENLO AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4734
Mailing Address - Country:US
Mailing Address - Phone:650-275-4577
Mailing Address - Fax:
Practice Address - Street 1:830 MENLO AVE STE 200
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4734
Practice Address - Country:US
Practice Address - Phone:650-275-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114040177OtherNPI