Provider Demographics
NPI:1275839045
Name:LAW, THERESA DRISCOLL (MFT)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:DRISCOLL
Last Name:LAW
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1486 HUNTINGTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5970
Mailing Address - Country:US
Mailing Address - Phone:650-877-8642
Mailing Address - Fax:
Practice Address - Street 1:1486 HUNTINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5970
Practice Address - Country:US
Practice Address - Phone:650-877-8642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46041106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist