Healthcare Provider Details

I. General information

NPI: 1053345116
Provider Name (Legal Business Name): MATTHEW ADAM LIPSON LICSW, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 FOREST RD
SALISBURY MA
01952-1604
US

IV. Provider business mailing address

102 FOREST RD
SALISBURY MA
01952-1604
US

V. Phone/Fax

Practice location:
  • Phone: 978-317-4266
  • Fax: 781-599-5051
Mailing address:
  • Phone: 978-317-4266
  • Fax: 781-599-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113093
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: