MEDICARE: LIYUAN WANG LCSW PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1619804598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIYUAN WANG LCSW PLLC

Provider Business Mailing Address
First Line	:	4370 KISSENA BLVD APT 26E
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-3750
Country	:	US
Telephone Number	:	765-277-4585
Fax Number	:

Provider Business Practice Location Address
First Line	:	4370 KISSENA BLVD APT 26E
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-3750
Country	:	US
Telephone Number	:	765-277-4585
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	LIYUAN WANG
Credential	:	LCSW, CCM
Telephone Number	:	765-277-4585

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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