MEDICARE: DR. JOANNA LIPARI PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY22285	CA

General Provider Information

NPI Number	:	1073825907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANNA LIPARI PSYD

Provider Business Mailing Address
First Line	:	1110 PINE ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3926
Country	:	US
Telephone Number	:	310-581-8823
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 S BARRINGTON AVE STE 304
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5379
Country	:	US
Telephone Number	:	310-581-8823
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	07/08/2010

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