Provider Demographics
NPI:1457600728
Name:FENG, LUISA YUE
Entity Type:Individual
Prefix:MS
First Name:LUISA
Middle Name:YUE
Last Name:FENG
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 1:75 CHRISTOPHER ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1206
Mailing Address - Country:US
Mailing Address - Phone:617-282-2584
Mailing Address - Fax:
Practice Address - Street 1:75 CHRISTOPHER ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1206
Practice Address - Country:US
Practice Address - Phone:617-282-2584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1307576Medicaid
MAM18463OtherBLUE CROSS/BLUE SHIELD
MA1303295Medicaid
MA1303295Medicaid