MEDICARE: MS. PATRICIA A WIPPICH MSW 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	44SC00187500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44768	OTHER		UNITED BEHAVIORAL HEALTH
2	P530	OTHER		OXFORD HEALTHCARE
3	1271	OTHER	NJ	ST BARNABAS HEALTHCARE
4	1281	OTHER		ST BARNABAS EAP
5	169288	OTHER		MHN

General Provider Information

NPI Number	:	1790719979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA A WIPPICH MSW LCSW

Provider Business Mailing Address
First Line	:	219 DENVER RD
Second Line	:
City	:	PARAMUS
State	:	NJ
Zip	:	07652-3205
Country	:	US
Telephone Number	:	201-265-0589
Fax Number	:	201-265-1989

Provider Business Practice Location Address
First Line	:	219 DENVER RD
Second Line	:
City	:	PARAMUS
State	:	NJ
Zip	:	07652-3205
Country	:	US
Telephone Number	:	201-265-0589
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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