=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700311271
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH LIPSCOMB LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2017
-----------------------------------------------------
Last Update Date | 04/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 349 E NORTHFIELD RD SUITE LL5
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-4802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-251-2874
-----------------------------------------------------
Fax | 973-251-2878
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 TUXEDO PKWY
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07106-2822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-709-3669
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC01382800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------