Provider Demographics
NPI:1053345116
Name:LIPSON, MATTHEW ADAM (LICSW, MSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ADAM
Last Name:LIPSON
Suffix:
Gender:M
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01952-1604
Mailing Address - Country:US
Mailing Address - Phone:978-317-4266
Mailing Address - Fax:781-599-5051
Practice Address - Street 1:102 FOREST RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MA
Practice Address - Zip Code:01952-1604
Practice Address - Country:US
Practice Address - Phone:978-317-4266
Practice Address - Fax:781-599-5051
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1130931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23762Medicare ID - Type Unspecified