MEDICARE: JENNIFER LIPACK LMHC, LMSW, CASAC

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	MH14086	FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	23848	NY
3	101YM0800X	Mental Health Counselor	004540	NY
4	104100000X	Social Worker	102752	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LMSW	OTHER	NY	LMSW

General Provider Information

NPI Number	:	1427368331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LIPACK LMHC, LMSW, CASAC

Provider Business Mailing Address
First Line	:	PO BOX 256
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-0256
Country	:	US
Telephone Number	:	917-574-8180
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 256
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-0256
Country	:	US
Telephone Number	:	917-574-8180
Fax Number	:

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

Provider Enumeration Date	:	10/13/2010
Last Update Date	:	12/19/2025

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