Provider Demographics
NPI:1992064240
Name:LIU EPSTEIN, SHAO J (LCSW-C)
Entity type:Individual
Prefix:
First Name:SHAO
Middle Name:J
Last Name:LIU EPSTEIN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:SHAO
Other - Middle Name:JU
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11124 SCEPTRE RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6342
Mailing Address - Country:US
Mailing Address - Phone:703-869-3196
Mailing Address - Fax:
Practice Address - Street 1:11124 SCEPTRE RIDGE TER
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-6342
Practice Address - Country:US
Practice Address - Phone:301-674-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD154021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05306Medicaid