Healthcare Provider Details

I. General information

NPI: 1194064626
Provider Name (Legal Business Name): MARK J LIPMAN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MILL ST
BELMONT MA
02478-1064
US

IV. Provider business mailing address

115 MILL ST
BELMONT MA
02478-1064
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-2000
  • Fax: 617-855-3724
Mailing address:
  • Phone: 617-855-2000
  • Fax: 617-855-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8165
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: