MEDICARE: MS. STEPHANIE KIPPERMAN LCSW

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	101YM0800X	Mental Health Counselor	LCS 14819	CA

General Provider Information

NPI Number	:	1245297126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE KIPPERMAN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 225112
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-5112
Country	:	US
Telephone Number	:	415-665-5135
Fax Number	:	415-665-5135

Provider Business Practice Location Address
First Line	:	946 IRVING ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-2207
Country	:	US
Telephone Number	:	415-665-5135
Fax Number	:	415-665-5135

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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