Provider Demographics
NPI:1710294301
Name:DAVID A. LIPSITZ, PH.D., INC
Entity Type:Organization
Organization Name:DAVID A. LIPSITZ, PH.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LIPSITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:636-441-3322
Mailing Address - Street 1:514 JUNGERMANN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2730
Mailing Address - Country:US
Mailing Address - Phone:636-441-3322
Mailing Address - Fax:636-441-4302
Practice Address - Street 1:514 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2730
Practice Address - Country:US
Practice Address - Phone:636-441-3322
Practice Address - Fax:636-441-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00061103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493218200Medicaid