Provider Demographics
NPI:1679056345
Name:LIPTON, LISA (LMFT PSYD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:LIPTON
Suffix:
Gender:
Credentials:LMFT PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 WILSHIRE BLVD STE 370
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4623
Mailing Address - Country:US
Mailing Address - Phone:832-215-5510
Mailing Address - Fax:
Practice Address - Street 1:5300 BEETHOVEN ST # A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7069
Practice Address - Country:US
Practice Address - Phone:310-462-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT135385106H00000X, 106H00000X
103T00000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA390200000XOtherTAXONOMY