Provider Demographics
NPI:1205208733
Name:WANG, LIYUAN (LMSW)
Entity Type:Individual
Prefix:
First Name:LIYUAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 KISSENA BLVD
Mailing Address - Street 2:APT 22L
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3769
Mailing Address - Country:US
Mailing Address - Phone:765-277-4585
Mailing Address - Fax:
Practice Address - Street 1:4370 KISSENA BLVD
Practice Address - Street 2:APT22L
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3769
Practice Address - Country:US
Practice Address - Phone:765-277-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094035104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker