Provider Demographics
NPI:1518472406
Name:LUO, XIAO
Entity type:Individual
Prefix:
First Name:XIAO
Middle Name:
Last Name:LUO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14016 34TH AVE APT 1101
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3061
Mailing Address - Country:US
Mailing Address - Phone:385-309-8053
Mailing Address - Fax:
Practice Address - Street 1:14016 34TH AVE APT 1101
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3061
Practice Address - Country:US
Practice Address - Phone:385-309-8053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-24-73849103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst