Healthcare Provider Details

I. General information

NPI: 1811686868
Provider Name (Legal Business Name): ELISABETH ANNE LIPTAK MA, LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5039 CONNECTICUT AVE NW STE 7
WASHINGTON DC
20008-2056
US

IV. Provider business mailing address

4700 CONNECTICUT AVE NW APT 408
WASHINGTON DC
20008-5609
US

V. Phone/Fax

Practice location:
  • Phone: 202-660-1422
  • Fax:
Mailing address:
  • Phone: 202-669-0859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20001487
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: