Provider Demographics
NPI:1801608633
Name:LIPPERT, MADELINE LEIGH
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:LEIGH
Last Name:LIPPERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 DITMAS AVE APT 5L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-6019
Mailing Address - Country:US
Mailing Address - Phone:404-626-4050
Mailing Address - Fax:
Practice Address - Street 1:1002 DITMAS AVE APT 5L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-6019
Practice Address - Country:US
Practice Address - Phone:404-626-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency