Provider Demographics
NPI:1891149845
Name:LIPSEY, NICOLE ALYCE
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ALYCE
Last Name:LIPSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:A
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CROW CANYON CT.
Mailing Address - Street 2:STE #100
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:888-531-8385
Mailing Address - Fax:925-264-1902
Practice Address - Street 1:1 CROW CANYON CT.
Practice Address - Street 2:STE #100
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:888-531-8385
Practice Address - Fax:925-264-1902
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst