Provider Demographics
NPI:1891430195
Name:LIU, XIAOFANG
Entity Type:Individual
Prefix:
First Name:XIAOFANG
Middle Name:
Last Name:LIU
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 1:155 W 68TH ST APT 218
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5824
Mailing Address - Country:US
Mailing Address - Phone:917-650-6537
Mailing Address - Fax:
Practice Address - Street 1:14330 38TH AVE APT 1D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5720
Practice Address - Country:US
Practice Address - Phone:888-370-2170
Practice Address - Fax:888-370-2170
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker