Healthcare Provider Details

I. General information

NPI: 1306348016
Provider Name (Legal Business Name): BRANDON MICHAEL LIPIN PSY.D., MSCP, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 04/06/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S RAND RD STE 211
LAKE ZURICH IL
60047-2307
US

IV. Provider business mailing address

444 S RAND RD STE 211
LAKE ZURICH IL
60047-2307
US

V. Phone/Fax

Practice location:
  • Phone: 847-660-4946
  • Fax:
Mailing address:
  • Phone: 847-660-4946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number35368
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.021047
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: