Provider Demographics
NPI:1780308312
Name:TAM-LIAO, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:TAM-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 1:16904 77TH RD
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1336
Mailing Address - Country:US
Mailing Address - Phone:917-601-3024
Mailing Address - Fax:
Practice Address - Street 1:16904 77TH RD
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1336
Practice Address - Country:US
Practice Address - Phone:917-601-3024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076433104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker