Provider Demographics
NPI:1780608687
Name:LIPSON, JONI R (MA, LLP)
Entity type:Individual
Prefix:MS
First Name:JONI
Middle Name:R
Last Name:LIPSON
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 MYSTIC VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1437
Mailing Address - Country:US
Mailing Address - Phone:248-361-9314
Mailing Address - Fax:
Practice Address - Street 1:3910 TELEGRAPH RD
Practice Address - Street 2:STE 202
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1420
Practice Address - Country:US
Practice Address - Phone:248-686-0345
Practice Address - Fax:248-686-0344
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301013357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7509104190OtherBCBSM MENTAL HEALTH PROV
MI028363OtherV ALUE OPTIONS
MI258694OtherMHN PIN
MI1705289Medicaid
MI0911419OtherBCBSM MESSA/ MAGELLAN
MI20530OtherBCBSM SUBSTANCE ABUSE PIN
MI130958OtherCARE CHOICES & PREFERRED
MI1063603106OtherHEALTH PLUS PIN
MI5266701OtherAETNA BEHAVIORAL HEALTH