Provider Demographics
NPI:1548391840
Name:LIPSITZ, NEAL ENNIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:ENNIS
Last Name:LIPSITZ
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 1:36 PEACH TREE DR
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-4804
Mailing Address - Country:US
Mailing Address - Phone:617-969-7876
Mailing Address - Fax:508-793-3334
Practice Address - Street 1:10 LANGLEY RD
Practice Address - Street 2:SUITE 401
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-1972
Practice Address - Country:US
Practice Address - Phone:617-969-7876
Practice Address - Fax:508-793-3334
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4365103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04552OtherBLUE CROSS BLUE SHIELD