Healthcare Provider Details

I. General information

NPI: 1568116945
Provider Name (Legal Business Name): MICHELLE LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 150TH ST
NEW YORK NY
10031-2449
US

IV. Provider business mailing address

6214 RIVERDALE AVE STE 1A
BRONX NY
10471-1032
US

V. Phone/Fax

Practice location:
  • Phone: 646-707-3100
  • Fax: 646-785-9392
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number068110-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: