Provider Demographics
NPI:1063593168
Name:LIPANI, LISA (LCSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:LIPANI
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 1:121 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1926
Mailing Address - Country:US
Mailing Address - Phone:585-248-9180
Mailing Address - Fax:585-248-9471
Practice Address - Street 1:121 BEVERLY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-1926
Practice Address - Country:US
Practice Address - Phone:585-248-9180
Practice Address - Fax:585-248-9471
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03200711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110791FKOtherPREFFERED CARE PIN #
7287381OtherAETNA PIN #