Healthcare Provider Details

I. General information

NPI: 1578742326
Provider Name (Legal Business Name): BENNY LIU MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 LEMON ST STE 207 4275 LEMON STREET. #207
RIVERSIDE CA
92501-3608
US

IV. Provider business mailing address

4275 LEMON ST STE 207 4275 LEMON STREET. #207
RIVERSIDE CA
92501-3608
US

V. Phone/Fax

Practice location:
  • Phone: 951-328-2280
  • Fax:
Mailing address:
  • Phone: 951-328-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: