Provider Demographics
NPI:1114497294
Name:LIPKA, JEREMY BRYAN (CARC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:BRYAN
Last Name:LIPKA
Suffix:
Gender:M
Credentials:CARC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3224
Mailing Address - Country:US
Mailing Address - Phone:413-333-9677
Mailing Address - Fax:413-773-0477
Practice Address - Street 1:1221 MAIN ST STE 309
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5396
Practice Address - Country:US
Practice Address - Phone:413-316-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist