Healthcare Provider Details

I. General information

NPI: 1952701088
Provider Name (Legal Business Name): DR. RICHARD TONY LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MGH PRACTICE 55 FRUIT STREET
BOSTON MA
02114
US

IV. Provider business mailing address

1 BOWDOIN SQ
BOSTON MA
02114-2927
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2000
  • Fax:
Mailing address:
  • Phone: 617-726-8895
  • Fax: 617-643-7941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS01457
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS01457
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01457
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS01457
License Number StateRI
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11436
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: