Provider Demographics
NPI:1396746178
Name:LIPKIN, LAURA ROBIN (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ROBIN
Last Name:LIPKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE G2
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1108
Mailing Address - Country:US
Mailing Address - Phone:610-664-0448
Mailing Address - Fax:215-836-1534
Practice Address - Street 1:100 PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE G2
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1108
Practice Address - Country:US
Practice Address - Phone:610-664-0448
Practice Address - Fax:215-836-1534
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004354-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1294100Medicaid
PA0062946000OtherPERSONAL CHOICE
620000976OtherRAILROAD MEDICARE
620000976OtherRAILROAD MEDICARE
PA1294100Medicaid