MEDICARE: LAURETTE LIPMAN LPCC

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	7364	CA
2	101YM0800X	Mental Health Counselor	6401013286	MI

General Provider Information

NPI Number	:	1770854978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURETTE LIPMAN LPCC

Provider Business Mailing Address
First Line	:	133 1/2 KENTUCKY ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-2925
Country	:	US
Telephone Number	:	650-360-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 1/2 KENTUCKY ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-2925
Country	:	US
Telephone Number	:	650-360-2211
Fax Number	:

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

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	03/01/2024

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Directions to “ LAURETTE LIPMAN LPCC” Practice Location

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