MEDICARE: KEVIN FREDERICK LIPPE JR.

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
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1497597991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN FREDERICK LIPPE JR.

Provider Business Mailing Address
First Line	:	29 WALNUT ST
Second Line	:
City	:	EAST PROVIDENCE
State	:	RI
Zip	:	02914-4425
Country	:	US
Telephone Number	:	401-527-0174
Fax Number	:

Provider Business Practice Location Address
First Line	:	3045 TOWER HILL RD
Second Line	:
City	:	SAUNDERSTOWN
State	:	RI
Zip	:	02874-1501
Country	:	US
Telephone Number	:	401-789-0934
Fax Number	:

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

Provider Enumeration Date	:	06/07/2024
Last Update Date	:	06/07/2024

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