Provider Demographics
NPI:1356540173
Name:LIPSON, MINDY BETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:BETH
Last Name:LIPSON
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14575 W MOUNTAIN VIEW BLVD UNIT 10307
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8672
Mailing Address - Country:US
Mailing Address - Phone:646-361-5251
Mailing Address - Fax:
Practice Address - Street 1:14575 W MOUNTAIN VIEW BLVD UNIT 10307
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8672
Practice Address - Country:US
Practice Address - Phone:646-361-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4093103TC0700X, 103TC0700X
NY017163103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth