Provider Demographics
NPI:1417192600
Name:LIPMANSON, RAVEN (MD)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:LIPMANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13001 EAST 17TH PLACE
Mailing Address - Street 2:ROOM E2322 MAIL STOP F546 BUILDING 500
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:303-724-6018
Mailing Address - Fax:
Practice Address - Street 1:13001 EAST 17TH PLACE
Practice Address - Street 2:RM E2322 MAIL STOP F546 BUILDING 500
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:303-724-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1052832084P0800X
CO488192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry