MEDICARE: MS. AMBER LIPONOGA 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	1041C0700X	Clinical Social Worker	2019027191	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639763147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMBER LIPONOGA LCSW

Provider Business Mailing Address
First Line	:	115 CONLEY RD # 1032
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-6465
Country	:	US
Telephone Number	:	573-212-4456
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 FELLOWS PL APT 3C
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-8529
Country	:	US
Telephone Number	:	573-823-2842
Fax Number	:

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

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	04/05/2025

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