Provider Demographics
NPI:1679188254
Name:LIPSON, BRIAN
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LIPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 W METROPOLITAN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3502
Mailing Address - Country:US
Mailing Address - Phone:949-401-3931
Mailing Address - Fax:888-403-6922
Practice Address - Street 1:4050 W METROPOLITAN DR STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3502
Practice Address - Country:US
Practice Address - Phone:949-401-3931
Practice Address - Fax:888-403-6922
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-23-69647103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst