Provider Demographics
NPI:1376681924
Name:LAW, CAROL LYNNE (MFT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LYNNE
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 1:902 CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2108
Mailing Address - Country:US
Mailing Address - Phone:510-559-8895
Mailing Address - Fax:510-558-8828
Practice Address - Street 1:902 CURTIS ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2108
Practice Address - Country:US
Practice Address - Phone:510-559-8895
Practice Address - Fax:510-558-8828
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 27313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist