Provider Demographics
NPI:1205080215
Name:LIPPMAN, SUSAN ELLEN (LMSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELLEN
Last Name:LIPPMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3457 73RD ST #3A
Mailing Address - Street 2:3A
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2170
Mailing Address - Country:US
Mailing Address - Phone:718-639-5969
Mailing Address - Fax:
Practice Address - Street 1:3457 73RD ST #3A
Practice Address - Street 2:3A
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-639-5969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023-037-1104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker