Provider Demographics
NPI:1780027037
Name:LIANG, ALICE (PHD, MPH)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:LIANG
Suffix:
Gender:F
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 MADERA RD STE 5-388
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4045
Mailing Address - Country:US
Mailing Address - Phone:925-698-7994
Mailing Address - Fax:
Practice Address - Street 1:1230 MADERA RD STE 5-388
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4045
Practice Address - Country:US
Practice Address - Phone:925-698-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24954103T00000X
CAPSY24954103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist