Provider Demographics
NPI:1275611824
Name:LIPSKY, CAROL M (PSYD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:LIPSKY
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 1:181 VALLEY STREAM CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5818
Mailing Address - Country:US
Mailing Address - Phone:610-436-1611
Mailing Address - Fax:610-436-1611
Practice Address - Street 1:181 VALLEY STREAM CIRCLE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-5818
Practice Address - Country:US
Practice Address - Phone:610-436-1611
Practice Address - Fax:610-436-1611
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSO08844L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
036659Medicare ID - Type Unspecified