MEDICARE: STEPHANIE LIU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301019739	MI

General Provider Information

NPI Number	:	1275480782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LIU

Provider Business Mailing Address
First Line	:	34415 SANDPEBBLE DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-5559
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	34415 SANDPEBBLE DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-5559
Country	:	US
Telephone Number	:	310-701-6628
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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Directions to “ STEPHANIE LIU ” Practice Location

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