Provider Demographics
NPI:1174596407
Name:LIPPITT, ELIZABETH ANN (LISW LICDC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:LIPPITT
Suffix:
Gender:F
Credentials:LISW LICDC
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:LIPPITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW LICDC
Mailing Address - Street 1:4384 INNES AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1710
Mailing Address - Country:US
Mailing Address - Phone:513-542-1577
Mailing Address - Fax:513-542-0616
Practice Address - Street 1:4039 HAMILTON AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-2601
Practice Address - Country:US
Practice Address - Phone:513-505-2446
Practice Address - Fax:513-542-0616
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00089551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLISW23752Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER