Healthcare Provider Details

I. General information

NPI: 1275300824
Provider Name (Legal Business Name): ELIZABETH LIPKER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 THURBER DR
WATERLOO NY
13165-1665
US

IV. Provider business mailing address

14416 W MEEKER BLVD BLDG C
SUN CITY WEST AZ
85375-5284
US

V. Phone/Fax

Practice location:
  • Phone: 315-539-1980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW-22723
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: