Provider Demographics
NPI:1821352055
Name:SIMONS-LIPSHUTZ, MICHELLE RANDY (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RANDY
Last Name:SIMONS-LIPSHUTZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 HAMMOND RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3302
Mailing Address - Country:US
Mailing Address - Phone:267-251-0466
Mailing Address - Fax:
Practice Address - Street 1:8121 HAMMOND RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3333
Practice Address - Country:US
Practice Address - Phone:267-251-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000052106H00000X
PABH001264103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist