Provider Demographics
NPI:1619605482
Name:LIPSEY, SUSAN WALSH (BCBA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:WALSH
Last Name:LIPSEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 S ARLINGTON MILL DR UNIT 106
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3404
Mailing Address - Country:US
Mailing Address - Phone:571-409-0180
Mailing Address - Fax:
Practice Address - Street 1:2720 S ARLINGTON MILL DR UNIT 106
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3404
Practice Address - Country:US
Practice Address - Phone:571-409-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001988103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst