Healthcare Provider Details

I. General information

NPI: 1861485468
Provider Name (Legal Business Name): JAMES MICHAEL LIPSKI LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 LORING AVE
SALEM MA
01970-4236
US

IV. Provider business mailing address

564 LORING AVE
SALEM MA
01970-4236
US

V. Phone/Fax

Practice location:
  • Phone: 978-741-8066
  • Fax:
Mailing address:
  • Phone: 978-741-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104443
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: