Healthcare Provider Details

I. General information

NPI: 1912824343
Provider Name (Legal Business Name): EMMA LIPOVETSKY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMA GOLDMAN

II. Dates (important events)

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

III. Provider practice location address

1448 N 31ST ST
FORT DODGE IA
50501-8025
US

IV. Provider business mailing address

1448 N 31ST ST
FORT DODGE IA
50501-8025
US

V. Phone/Fax

Practice location:
  • Phone: 818-237-6077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number138299
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: