Provider Demographics
NPI:1639195266
Name:ESAU, PAMELA J (PSYD,LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:ESAU
Suffix:
Gender:F
Credentials:PSYD,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23461 SOUTH POINTE DRIVE
Mailing Address - Street 2:SUITE 375
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-509-8271
Mailing Address - Fax:949-581-9559
Practice Address - Street 1:23461 SOUTH POINTE DRIVE
Practice Address - Street 2:SUITE 375
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-509-8271
Practice Address - Fax:949-581-9559
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 173271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW17327Medicare ID - Type UnspecifiedSOCIAL WORK