MEDICARE: XING 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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	093452	NY

General Provider Information

NPI Number	:	1679069108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XING LIU

Provider Business Mailing Address
First Line	:	4142 24TH ST APT 519
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3977
Country	:	US
Telephone Number	:	706-254-6310
Fax Number	:	706-254-6310

Provider Business Practice Location Address
First Line	:	4142 24TH ST APT 519
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3977
Country	:	US
Telephone Number	:	706-254-6310
Fax Number	:

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

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	06/15/2022

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Directions to “ XING LIU ” Practice Location

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