Provider Demographics
NPI:1063444867
Name:LIPSON, GLENN SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:SCOTT
Last Name:LIPSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 8621
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067
Mailing Address - Country:US
Mailing Address - Phone:858-759-1848
Mailing Address - Fax:858-759-1098
Practice Address - Street 1:16236 SAN DIEGUITO RD
Practice Address - Street 2:SUITE 3-23
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92091-9802
Practice Address - Country:US
Practice Address - Phone:858-759-1848
Practice Address - Fax:858-759-1098
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11335103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist