Provider Demographics
NPI:1548403132
Name:LIPSITZ, ROBERTA J (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:J
Last Name:LIPSITZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7572 REGENCY LAKE DR
Mailing Address - Street 2:APT. C-301
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2835
Mailing Address - Country:US
Mailing Address - Phone:561-447-8842
Mailing Address - Fax:561-447-9809
Practice Address - Street 1:7572 REGENCY LAKE DR
Practice Address - Street 2:APT. C-301
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2835
Practice Address - Country:US
Practice Address - Phone:561-447-8842
Practice Address - Fax:561-447-9809
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-12
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2408171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689783579OtherMEDICAID WAIVER