Provider Demographics
NPI:1023238573
Name:LIAO, PEN-LUNG (LMFT)
Entity type:Individual
Prefix:
First Name:PEN-LUNG
Middle Name:
Last Name:LIAO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 BRODERICK ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3304
Mailing Address - Country:US
Mailing Address - Phone:415-292-1760
Mailing Address - Fax:415-292-1636
Practice Address - Street 1:1421 BRODERICK STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3304
Practice Address - Country:US
Practice Address - Phone:415-292-1760
Practice Address - Fax:415-292-1636
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43668106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist