Provider Demographics
NPI:1508162066
Name:LIPINSKI, DAMON HENRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:HENRY
Last Name:LIPINSKI
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 1:519 LATHAM DR
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-8360
Mailing Address - Country:US
Mailing Address - Phone:479-750-0125
Mailing Address - Fax:479-750-0323
Practice Address - Street 1:519 LATHAM DR
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-8360
Practice Address - Country:US
Practice Address - Phone:479-750-0125
Practice Address - Fax:479-750-0323
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2911103G00000X, 103TC0700X
AR11-12P103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4A069Medicare PIN