Healthcare Provider Details

I. General information

NPI: 1477839025
Provider Name (Legal Business Name): NANNAN LIU LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 W END AVE APT R21C
NEW YORK NY
10023-7889
US

IV. Provider business mailing address

160 W 71ST ST 7T
NEW YORK NY
10023-3901
US

V. Phone/Fax

Practice location:
  • Phone: 646-436-2221
  • Fax:
Mailing address:
  • Phone: 646-436-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005461
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: