Healthcare Provider Details

I. General information

NPI: 1356540173
Provider Name (Legal Business Name): MINDY BETH LIPSON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9223 W KINGS AVE
PEORIA AZ
85382-3556
US

IV. Provider business mailing address

9223 W KINGS AVE
PEORIA AZ
85382-3556
US

V. Phone/Fax

Practice location:
  • Phone: 646-361-5251
  • Fax:
Mailing address:
  • Phone: 646-361-5251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4093
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: