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NPI Code Detail

MEDICARE: DR. WENDY LIPPE

MEDICARE: DR. WENDY LIPPE
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
1103TB0200XCognitive & Behavioral Psychologist7267MA
2103TC0700XClinical Psychologist7267MA

General Provider Information

NPI Number : 1679807846
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WENDY LIPPE
Provider Business Mailing Address
First Line : 22 HILLIARD ST
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02138-4972
Country : US
Telephone Number : 617-491-5515
Fax Number :
Provider Business Practice Location Address
First Line : 22 HILLIARD ST
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02138-4972
Country : US
Telephone Number : 617-491-5515
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2009
Last Update Date : 09/22/2009

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