Healthcare Provider Details

I. General information

NPI: 1093991663
Provider Name (Legal Business Name): HEATHER MARIE LIPPERT L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 EL CAJON BLVD
SAN DIEGO CA
92115-3621
US

IV. Provider business mailing address

3020 CHILDREN'S WAY MC 5018 RADY CHILDREN'S HOSPITAL; OUTPATIENT PSYCHIATRY
SAN DIEGO CA
92123-4282
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2400
  • Fax:
Mailing address:
  • Phone: 619-758-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS22526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: