Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 160181735 | CA |
NPI | 1053880625 |
---|---|
Provider Name | Serena Lau-Brazell |
First Address | Daly City, CA 94015-3519 |
Second Address | Daly City, CA 94015-3519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2018 |
Last Update Date | 13/11/2018 |