Provider Demographics
NPI:1053459339
Name:LIPNER, JOANNE DALE
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:DALE
Last Name:LIPNER
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 1:45 BARTLETT CRESCENT
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2220
Mailing Address - Country:US
Mailing Address - Phone:617-566-3105
Mailing Address - Fax:
Practice Address - Street 1:45 BARTLETT CRESCENT
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2220
Practice Address - Country:US
Practice Address - Phone:617-566-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2012-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103343MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01326OtherBCBS
MAP01326Medicare ID - Type Unspecified