Healthcare Provider Details

I. General information

NPI: 1194548917
Provider Name (Legal Business Name): XIAOHUAN LI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 BEACON ST
BROOKLINE MA
02446-4602
US

IV. Provider business mailing address

1 S POINT DR APT 505
DORCHESTER MA
02125-3523
US

V. Phone/Fax

Practice location:
  • Phone: 857-693-8800
  • Fax:
Mailing address:
  • Phone: 617-870-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: