Provider Demographics
NPI:1154608529
Name:KIPNIS, TAMAR (MS, LP, LCAT,)
Entity type:Individual
Prefix:
First Name:TAMAR
Middle Name:
Last Name:KIPNIS
Suffix:
Gender:F
Credentials:MS, LP, LCAT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 BROADWAY
Mailing Address - Street 2:8TH FLOOR #12
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6004
Mailing Address - Country:US
Mailing Address - Phone:212-252-2417
Mailing Address - Fax:
Practice Address - Street 1:920 BROADWAY
Practice Address - Street 2:8TH FLOOR #12
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6004
Practice Address - Country:US
Practice Address - Phone:212-252-2417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCAT 000062101YM0800X
NY000189102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY# 300615844OtherEIN