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General NPI Number Information
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NPI Number | 1639240591
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Entity Type | Individual
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Provider Name | LENORE MARIE TIPPING PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15 COLUMBIA ST SUITE 402
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City | BANGOR
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State | ME
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Zip | 04401-6355
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Country | US
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Telephone | 207-942-2151
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Fax | 207-942-2151
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Provider Business Mailing Address
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Address Line | 14 KELL ST
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City | ORONO
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State | ME
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Zip | 04473-4240
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Country | US
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Telephone | 207-866-2061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS957
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License Number State | ME
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