Provider Demographics
NPI:1225310857
Name:LIPSON, STACEY (PSYD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:LIPSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 TOUHY AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3253
Mailing Address - Country:US
Mailing Address - Phone:773-466-0847
Mailing Address - Fax:
Practice Address - Street 1:5550 TOUHY AVE STE 404
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3253
Practice Address - Country:US
Practice Address - Phone:773-466-0847
Practice Address - Fax:708-681-9280
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist