Provider Demographics
NPI:1467440065
Name:LIPETZKY, JOSEPH AL (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:AL
Last Name:LIPETZKY
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1755 N WESTGATE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7176
Mailing Address - Country:US
Mailing Address - Phone:208-373-0790
Mailing Address - Fax:208-373-0816
Practice Address - Street 1:1755 N WESTGATE DR STE 260
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7176
Practice Address - Country:US
Practice Address - Phone:208-373-0790
Practice Address - Fax:208-373-0816
Is Sole Proprietor?:No
Enumeration Date:2005-10-09
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY 338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID00010016100OtherREGENCE BLUE SHIELD
IDN5509OtherBLUE CROSS
IDN5509OtherBLUE CROSS