Provider Demographics
NPI:1184766396
Name:CORNERSTONE PSYCHOLOGICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:CORNERSTONE PSYCHOLOGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:AL
Authorized Official - Last Name:LIPETZKY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:208-373-0790
Mailing Address - Street 1:1755 N WESTGATE DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7174
Mailing Address - Country:US
Mailing Address - Phone:208-373-0790
Mailing Address - Fax:208-373-0816
Practice Address - Street 1:1755 WESTGATE DR
Practice Address - Street 2:SUITE 260
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7174
Practice Address - Country:US
Practice Address - Phone:208-373-0790
Practice Address - Fax:208-373-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID342018OtherMANAGED HEALTH NETWORK
ID8G759OtherBLUE CROSS OF IDAHO
ID1375138Medicare ID - Type Unspecified