Healthcare Provider Details

I. General information

NPI: 1750453106
Provider Name (Legal Business Name): MARIO LIPPY PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 W FRYE RD STE 208
CHANDLER AZ
85224-6279
US

IV. Provider business mailing address

2081 W FRYE RD STE 208
CHANDLER AZ
85224-6279
US

V. Phone/Fax

Practice location:
  • Phone: 480-524-0990
  • Fax:
Mailing address:
  • Phone: 480-524-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLISAC11042
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-004234
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: