Healthcare Provider Details

I. General information

NPI: 1144965153
Provider Name (Legal Business Name): BETTY LIU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 LOMITA BLVD
TORRANCE CA
90505-5002
US

IV. Provider business mailing address

3330 LOMITA BLVD
TORRANCE CA
90505-5002
US

V. Phone/Fax

Practice location:
  • Phone: 310-517-7070
  • Fax:
Mailing address:
  • Phone: 310-517-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: