Provider Demographics
NPI:1396079745
Name:LIPKIN, MARISSA STACEY (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:STACEY
Last Name:LIPKIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 HARRITON RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2907
Mailing Address - Country:US
Mailing Address - Phone:917-699-2209
Mailing Address - Fax:
Practice Address - Street 1:721 HARRITON RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2907
Practice Address - Country:US
Practice Address - Phone:917-669-2209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019017103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical