Healthcare Provider Details

I. General information

NPI: 1619804598
Provider Name (Legal Business Name): LIYUAN WANG LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 KISSENA BLVD APT 26E
FLUSHING NY
11355-3750
US

IV. Provider business mailing address

4370 KISSENA BLVD APT 26E
FLUSHING NY
11355-3750
US

V. Phone/Fax

Practice location:
  • Phone: 765-277-4585
  • Fax:
Mailing address:
  • Phone: 765-277-4585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LIYUAN WANG
Title or Position: MANAGING MEMBER
Credential: LCSW, CCM
Phone: 765-277-4585