1972540839 NPI number — KAREN DOROTHY LIPPY RN MS CS-P MAC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972540839 NPI number — KAREN DOROTHY LIPPY RN MS CS-P MAC

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LIPPY

Provider First Name:

KAREN

Provider Middle Name:

DOROTHY

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

RN MS CS-P MAC

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

FETHE

Provider Other First Name:

KAREN

Provider Other Middle Name:

DOROTHY

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

1

NPI Number:

1972540839

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/09/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2519 BIRD VIEW RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WESTMINSTER

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21157-8309

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-840-8850

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

40 S CHURCH ST

Provider Second Line Business Practice Location Address:

SUITE 105

Provider Business Practice Location Address City Name:

WESTMINSTER

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21157-5414

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-848-9244

Provider Business Practice Location Address Fax Number:

410-876-5042

Provider Enumeration Date:

06/01/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 163WP0809X , with the licence number:  RO48443 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 217988 . This is a "KAISER PERMANENTE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 222912 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 224314 . This is a "COMPSYCH CORP." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: PVPB2364 . This is a "AMERICAN PSYCH SYSTEMS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 001470 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 528921-01 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: PQ82 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 001470 . This is a "OPTIONS MENTAL HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 5009458 . This is a "AETNA HEALTH PLANS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: PVPB 23640000 . This is a "PREFERRED HEALTH NETWORK" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 222912 . This is a "ALLIANCE HEALTH PLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: M074-0001 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".