Healthcare Provider Details

I. General information

NPI: 1427368331
Provider Name (Legal Business Name): JENNIFER LIPACK LMHC, LMSW, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 256
BALDWIN NY
11510-0256
US

IV. Provider business mailing address

PO BOX 256
BALDWIN NY
11510-0256
US

V. Phone/Fax

Practice location:
  • Phone: 917-574-8180
  • Fax:
Mailing address:
  • Phone: 917-574-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14086
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23848
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004540
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number102752
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: