Provider Demographics
NPI:1588193619
Name:LIPSCHUTZ, SIRENE ROSE (LMSW)
Entity Type:Individual
Prefix:
First Name:SIRENE
Middle Name:ROSE
Last Name:LIPSCHUTZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 E INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-6109
Mailing Address - Country:US
Mailing Address - Phone:928-714-5271
Mailing Address - Fax:
Practice Address - Street 1:2695 E INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-6109
Practice Address - Country:US
Practice Address - Phone:928-714-5271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSW-16607104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker