Provider Demographics
NPI:1730423294
Name:LIPPA, SARA (PHD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:LIPPA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 S PALMER RD RM 1502E
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5649
Mailing Address - Country:US
Mailing Address - Phone:301-319-3671
Mailing Address - Fax:
Practice Address - Street 1:4860 S PALMER RD RM 1502E
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5649
Practice Address - Country:US
Practice Address - Phone:301-319-3671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103G00000X
MD05440103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical