Provider Demographics
NPI:1720393242
Name:LIANG, ADELEINE CONANAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADELEINE
Middle Name:CONANAN
Last Name:LIANG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ADELEINE
Other - Middle Name:
Other - Last Name:CONANAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 161247
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92176-1247
Mailing Address - Country:US
Mailing Address - Phone:619-436-4231
Mailing Address - Fax:
Practice Address - Street 1:5230 CARROLL CANYON RD STE 316
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1781
Practice Address - Country:US
Practice Address - Phone:619-436-4231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
CA31748103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health