Healthcare Provider Details

I. General information

NPI: 1669118873
Provider Name (Legal Business Name): REBECCA LIPSCHUTZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 NORTHEAST EXPY NE
BROOKHAVEN GA
30329-2480
US

IV. Provider business mailing address

1777 NORTHEAST EXPY NE
BROOKHAVEN GA
30329-2480
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-7878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY900383
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: