Provider Demographics
NPI:1871861781
Name:PRECIADO, LAURA MERCEDES (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MERCEDES
Last Name:PRECIADO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 HUNTINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5444
Mailing Address - Country:US
Mailing Address - Phone:626-356-5374
Mailing Address - Fax:
Practice Address - Street 1:1499 HUNTINGTON DR STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5444
Practice Address - Country:US
Practice Address - Phone:626-356-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA727241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical