Provider Demographics
NPI:1912023946
Name:LIU, CATHY (LICSW)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, JD
Mailing Address - Street 1:187 LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2441
Mailing Address - Country:US
Mailing Address - Phone:781-956-6350
Mailing Address - Fax:
Practice Address - Street 1:500 UNICORN PARK DR
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-3377
Practice Address - Country:US
Practice Address - Phone:781-994-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210756104100000X
MA1148741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker