Provider Demographics
NPI:1760562573
Name:LIPMAN, KENNETH MARCUS (LPC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:MARCUS
Last Name:LIPMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2231
Mailing Address - Country:US
Mailing Address - Phone:732-729-9768
Mailing Address - Fax:732-729-9768
Practice Address - Street 1:24 N 3RD AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2429
Practice Address - Country:US
Practice Address - Phone:732-729-9768
Practice Address - Fax:732-729-9768
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPC00713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health