Provider Demographics
NPI:1841972106
Name:NG, LI TING EILEEN (PSYD)
Entity type:Individual
Prefix:
First Name:LI TING EILEEN
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CUMMINGS PARK STE 200
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2198
Mailing Address - Country:US
Mailing Address - Phone:781-305-4086
Mailing Address - Fax:781-305-4087
Practice Address - Street 1:21 CUMMINGS PARK STE 200
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2198
Practice Address - Country:US
Practice Address - Phone:781-305-4086
Practice Address - Fax:781-305-4087
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY5000512103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty