Provider Demographics
NPI:1083704415
Name:LIPPMAN, YETTA (ED D)
Entity Type:Individual
Prefix:DR
First Name:YETTA
Middle Name:
Last Name:LIPPMAN
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 HIDDEN TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2950
Mailing Address - Country:US
Mailing Address - Phone:831-479-3419
Mailing Address - Fax:
Practice Address - Street 1:820 BAY AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2140
Practice Address - Country:US
Practice Address - Phone:831-479-3419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA358833OtherMHN