Healthcare Provider Details

I. General information

NPI: 1790550887
Provider Name (Legal Business Name): JINGYI LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 MADISON AVE STE 400
NEW YORK NY
10016-5153
US

IV. Provider business mailing address

217 W 57TH ST APT 36B
NEW YORK NY
10019-2152
US

V. Phone/Fax

Practice location:
  • Phone: 212-889-4042
  • Fax:
Mailing address:
  • Phone: 917-349-4870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: