Provider Demographics
NPI:1245297126
Name:KIPPERMAN, STEPHANIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:KIPPERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 225112
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-5112
Mailing Address - Country:US
Mailing Address - Phone:415-665-5135
Mailing Address - Fax:415-665-5135
Practice Address - Street 1:946 IRVING ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2207
Practice Address - Country:US
Practice Address - Phone:415-665-5135
Practice Address - Fax:415-665-5135
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 14819101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22369ZMedicare ID - Type Unspecified