Provider Demographics
NPI:1194191205
Name:LIPPMAN, COLENE (PCCI)
Entity type:Individual
Prefix:
First Name:COLENE
Middle Name:
Last Name:LIPPMAN
Suffix:
Gender:F
Credentials:PCCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 EUCLID AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-3611
Mailing Address - Country:US
Mailing Address - Phone:619-266-2111
Mailing Address - Fax:
Practice Address - Street 1:286 EUCLID AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3611
Practice Address - Country:US
Practice Address - Phone:619-266-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health