MEDICARE: XIAONAN LIAO

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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1417442708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIAONAN LIAO

Provider Business Mailing Address
First Line	:	7720 160TH ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11366-1943
Country	:	US
Telephone Number	:	203-491-7332
Fax Number	:

Provider Business Practice Location Address
First Line	:	184 ELDRIDGE ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002-2992
Country	:	US
Telephone Number	:	212-562-4522
Fax Number	:

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

Provider Enumeration Date	:	06/28/2018
Last Update Date	:	06/28/2018

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Directions to “ XIAONAN LIAO ” Practice Location

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