Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1083277297 |
---|---|
Provider Name | Jessica Liu |
First Address | Cambridge, MA 02139-1047 |
Second Address | Cambridge, MA 02139-1099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2019 |
Last Update Date | 15/04/2019 |