Provider Demographics
NPI:1871810697
Name:LIPPY, /CELESTE RENE (MA)
Entity type:Individual
Prefix:
First Name:/CELESTE
Middle Name:RENE
Last Name:LIPPY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 E VAN BUREN ST STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6905
Mailing Address - Country:US
Mailing Address - Phone:602-652-5889
Mailing Address - Fax:602-273-2366
Practice Address - Street 1:4129 E VAN BUREN ST STE 250
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6905
Practice Address - Country:US
Practice Address - Phone:602-652-5889
Practice Address - Fax:602-273-2366
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health