Provider Demographics
NPI:1831805290
Name:LAL, AMITESHNI
Entity type:Individual
Prefix:
First Name:AMITESHNI
Middle Name:
Last Name:LAL
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 1:815 CARRIE ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-5428
Mailing Address - Country:US
Mailing Address - Phone:510-314-9008
Mailing Address - Fax:
Practice Address - Street 1:3123 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-7595
Practice Address - Country:US
Practice Address - Phone:925-999-4119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist