Provider Demographics
NPI:1609997352
Name:LIPTON, PATRICK P (MS)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:P
Last Name:LIPTON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 W GROVERS AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1300
Mailing Address - Country:US
Mailing Address - Phone:602-467-6520
Mailing Address - Fax:602-467-6580
Practice Address - Street 1:5130 W GROVERS AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1300
Practice Address - Country:US
Practice Address - Phone:602-467-6520
Practice Address - Fax:602-467-6580
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53248677103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool