Provider Demographics
NPI:1154691137
Name:LIPPERT, LEONARD LESTER JR (CLINICIAN)
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:LESTER
Last Name:LIPPERT
Suffix:JR
Gender:M
Credentials:CLINICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 E CHANNEL ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2322
Mailing Address - Country:US
Mailing Address - Phone:209-888-8327
Mailing Address - Fax:209-888-8327
Practice Address - Street 1:237 E CHANNEL ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2322
Practice Address - Country:US
Practice Address - Phone:209-888-8327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146656106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist