Provider Demographics
NPI:1255857546
Name:LAU, LILY (PHD)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 SHORELINE LOOP APT 239
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5513
Mailing Address - Country:US
Mailing Address - Phone:800-679-1730
Mailing Address - Fax:
Practice Address - Street 1:2040 SHORELINE LOOP APT 239
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5513
Practice Address - Country:US
Practice Address - Phone:800-679-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral