MEDICARE: DEBBIE S LIPSHUTZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	CW014155	PA
2	1041C0700X	Clinical Social Worker	CW014155	PA

General Provider Information

NPI Number	:	1568497089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE S LIPSHUTZ LCSW

Provider Business Mailing Address
First Line	:	6117 MCCALLUM ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-2603
Country	:	US
Telephone Number	:	215-432-4339
Fax Number	:	215-754-4339

Provider Business Practice Location Address
First Line	:	1 BALA AVENUE
Second Line	:	SUITE 110
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-3201
Country	:	US
Telephone Number	:	215-432-4339
Fax Number	:	215-754-4339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/21/2021

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