Healthcare Provider Details

I. General information

NPI: 1659106367
Provider Name (Legal Business Name): XIANGQUAN LUO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHAWN LUO

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HANCOCK ST STE 202
QUINCY MA
02171-2249
US

IV. Provider business mailing address

275 HANCOCK ST STE 202
QUINCY MA
02171-2249
US

V. Phone/Fax

Practice location:
  • Phone: 857-393-5769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: