Provider Demographics
NPI:1750453106
Name:LIPPY, MARIO (PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:LIPPY
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 E COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4382
Mailing Address - Country:US
Mailing Address - Phone:877-634-7333
Mailing Address - Fax:866-984-3891
Practice Address - Street 1:990 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1640
Practice Address - Country:US
Practice Address - Phone:877-634-7333
Practice Address - Fax:866-984-3891
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC11042101YM0800X
AZPSY004234103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPSY004234OtherARIZONA STATE BOARD OF PSYCHOLOGIST EXAMINERS