Healthcare Provider Details

I. General information

NPI: 1033129093
Provider Name (Legal Business Name): BEVERLY LIPSON L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 KINGS GATE RD
SUFFERN NY
10901-3111
US

IV. Provider business mailing address

2 KINGS GATE RD
SUFFERN NY
10901-3111
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-6690
  • Fax: 845-368-1726
Mailing address:
  • Phone: 845-357-6690
  • Fax: 845-368-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR05553
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC13636
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: