Provider Demographics
NPI:1417004425
Name:LIPSCOMB, THOMAS R (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:LIPSCOMB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 W AVON RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3679
Mailing Address - Country:US
Mailing Address - Phone:860-675-9509
Mailing Address - Fax:
Practice Address - Street 1:46 W AVON RD
Practice Address - Street 2:SUITE 302
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3679
Practice Address - Country:US
Practice Address - Phone:860-675-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT734103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical