1174596407 NPI number — ELIZABETH ANN LIPPITT LISW LICDC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174596407 NPI number — ELIZABETH ANN LIPPITT LISW LICDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPPITT
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LISW LICDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIPPITT
Provider Other First Name:
BETSY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LISW LICDC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1174596407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4384 INNES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45223-1710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-542-1577
Provider Business Mailing Address Fax Number:
513-542-0616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4039 HAMILTON AVE
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45223-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-505-2446
Provider Business Practice Location Address Fax Number:
513-542-0616
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I-0008955 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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