Provider Demographics
NPI:1033190277
Name:LIPSCHUTZ, JILL SUSANNE (MSS, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:SUSANNE
Last Name:LIPSCHUTZ
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 GAY ST
Mailing Address - Street 2:P.O. BOX 41010
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1310
Mailing Address - Country:US
Mailing Address - Phone:215-483-2321
Mailing Address - Fax:817-887-3339
Practice Address - Street 1:7401 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3005
Practice Address - Country:US
Practice Address - Phone:215-483-2321
Practice Address - Fax:817-887-3339
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0150451041C0700X
NJ44SC051281001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA040261Medicare ID - Type Unspecified