Healthcare Provider Details

I. General information

NPI: 1578630919
Provider Name (Legal Business Name): CHING TANG LIU LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TOM LIU LCSW

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 LONG BEACH BLVD
LONG BEACH CA
90806-5501
US

IV. Provider business mailing address

1975 LONG BEACH BLVD
LONG BEACH CA
90806-5501
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-9401
  • Fax: 562-218-0402
Mailing address:
  • Phone: 562-599-9401
  • Fax: 562-218-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS17385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: