Provider Demographics
NPI:1215979182
Name:LIU, LYDIA Z
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:Z
Last Name:LIU
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 1:280 WASHINGTON ST
Mailing Address - Street 2:#204
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3511
Mailing Address - Country:US
Mailing Address - Phone:617-783-7333
Mailing Address - Fax:617-783-1119
Practice Address - Street 1:280 WASHINGTON ST
Practice Address - Street 2:#204
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3511
Practice Address - Country:US
Practice Address - Phone:617-783-7333
Practice Address - Fax:617-783-1119
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216058171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist