Provider Demographics
NPI:1497056956
Name:LIPPE, J PAIGE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:PAIGE
Last Name:LIPPE
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CRESCENT PL
Mailing Address - Street 2:
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1402
Mailing Address - Country:US
Mailing Address - Phone:201-376-1393
Mailing Address - Fax:
Practice Address - Street 1:37 CRESCENT PL
Practice Address - Street 2:
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1402
Practice Address - Country:US
Practice Address - Phone:201-376-1393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-12561103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ599859OtherNEW JERSEY DEPARTMENT OF EDUCATION
NY764973OtherNEW YORK EDUCATION DEPARTMENT
NY764973OtherNEW YORK EDUCATION DEPARTMENT