Provider Demographics
NPI:1033354816
Name:LIPTON, BENJAMIN IRA (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:IRA
Last Name:LIPTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 WASHINGTON ST
Mailing Address - Street 2:3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3323
Mailing Address - Country:US
Mailing Address - Phone:212-691-5396
Mailing Address - Fax:
Practice Address - Street 1:626 WASHINGTON ST
Practice Address - Street 2:3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3323
Practice Address - Country:US
Practice Address - Phone:212-691-5396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049240-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN5J131Medicare PIN