Provider Demographics
NPI:1881179620
Name:LIPTAK, DONNA LEE (LICSW, LADC-I, CADC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LEE
Last Name:LIPTAK
Suffix:
Gender:F
Credentials:LICSW, LADC-I, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 PEQUOT POINT RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-5114
Mailing Address - Country:US
Mailing Address - Phone:413-203-5308
Mailing Address - Fax:
Practice Address - Street 1:78 PEQUOT POINT RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-5114
Practice Address - Country:US
Practice Address - Phone:413-203-5308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1029118-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical