Provider Demographics
NPI:1205964236
Name:LIPORACE, LISA SUSAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SUSAN
Last Name:LIPORACE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:402 VIA PLACITA
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1727
Mailing Address - Country:US
Mailing Address - Phone:561-630-5213
Mailing Address - Fax:561-656-2735
Practice Address - Street 1:580 VILLAGE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1904
Practice Address - Country:US
Practice Address - Phone:561-688-5050
Practice Address - Fax:561-688-9565
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW37291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical