Provider Demographics
NPI:1053745067
Name:LIU, JENNIFER (PC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:BRAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7140 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2261
Mailing Address - Country:US
Mailing Address - Phone:513-777-2428
Mailing Address - Fax:
Practice Address - Street 1:7140 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45069-2261
Practice Address - Country:US
Practice Address - Phone:513-777-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 1200233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health