Provider Demographics
NPI:1003685652
Name:LIANG, JIAQI HOLLY
Entity Type:Individual
Prefix:
First Name:JIAQI
Middle Name:HOLLY
Last Name:LIANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 73RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1901
Mailing Address - Country:US
Mailing Address - Phone:347-932-0467
Mailing Address - Fax:
Practice Address - Street 1:2571 47TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-1108
Practice Address - Country:US
Practice Address - Phone:929-277-1253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician