Provider Demographics
NPI:1730590415
Name:LIAO, PEI WEN
Entity type:Individual
Prefix:
First Name:PEI WEN
Middle Name:
Last Name:LIAO
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 1:6003 172ND ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1511
Mailing Address - Country:US
Mailing Address - Phone:929-992-0218
Mailing Address - Fax:
Practice Address - Street 1:140-15B SANFORD AVENUE, 2ND FL
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3024
Practice Address - Country:US
Practice Address - Phone:718-358-8288
Practice Address - Fax:718-358-5265
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health