Provider Demographics
NPI:1689748006
Name:LIPSON, MICHAEL AARON (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:AARON
Last Name:LIPSON
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:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:MILL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:01244-0265
Mailing Address - Country:US
Mailing Address - Phone:413-229-7772
Mailing Address - Fax:
Practice Address - Street 1:284 MAIN ST
Practice Address - Street 2:OFFICE 1
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1738
Practice Address - Country:US
Practice Address - Phone:413-528-4184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7615103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW50920Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION