Provider Demographics
NPI:1336197995
Name:LIU, MAN - (PH D)
Entity Type:Individual
Prefix:DR
First Name:MAN
Middle Name:-
Last Name:LIU
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ALDER LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4501
Mailing Address - Country:US
Mailing Address - Phone:203-806-8748
Mailing Address - Fax:203-806-8701
Practice Address - Street 1:57 NORTH STREET, SUITE 316
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5687
Practice Address - Country:US
Practice Address - Phone:203-915-7800
Practice Address - Fax:207-806-8701
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00002205103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist