Provider Demographics
NPI:1306348016
Name:LIPIN, BRANDON MICHAEL (PSYD, MSCP, CADC)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MICHAEL
Last Name:LIPIN
Suffix:
Gender:M
Credentials:PSYD, MSCP, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 S RAND RD STE 211
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2307
Mailing Address - Country:US
Mailing Address - Phone:847-660-4946
Mailing Address - Fax:
Practice Address - Street 1:444 S RAND RD STE 211
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2307
Practice Address - Country:US
Practice Address - Phone:847-660-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.021047103TC0700X
IL35368101YA0400X, 101YA0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL35368OtherIAODAPCA
IL071.021047OtherILLINOIS DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
IL35368OtherIAODAPCA
IL049.246255OtherILLINOIS DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION