Healthcare Provider Details

I. General information

NPI: 1003533670
Provider Name (Legal Business Name): YIXIN LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 BOX ST APT N531
BROOKLYN NY
11222-5686
US

IV. Provider business mailing address

28 BOX ST APT N531
BROOKLYN NY
11222-5686
US

V. Phone/Fax

Practice location:
  • Phone: 607-288-3689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116488
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: