Provider Demographics
NPI:1689230468
Name:WANG, LIREN
Entity Type:Individual
Prefix:
First Name:LIREN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIET
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:184 ELDRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-2992
Mailing Address - Country:US
Mailing Address - Phone:917-453-5732
Mailing Address - Fax:212-387-9186
Practice Address - Street 1:184 ELDRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2992
Practice Address - Country:US
Practice Address - Phone:917-453-5732
Practice Address - Fax:212-387-9186
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
P12078101YM0800X
NY011570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYZDW000000680OtherDISTRICT COUNCIL 1707