Provider Demographics
NPI:1598085458
Name:LAU, DANIELLE
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 LAURIE MEADOWS DR
Mailing Address - Street 2:535
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-4897
Mailing Address - Country:US
Mailing Address - Phone:650-576-9713
Mailing Address - Fax:
Practice Address - Street 1:397 LAURIE MEADOWS DR
Practice Address - Street 2:535
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-4897
Practice Address - Country:US
Practice Address - Phone:650-576-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60998106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist