Provider Demographics
NPI:1396797247
Name:TIPTON, CAROLYN W (LCSW, RN, RPT-S)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:W
Last Name:TIPTON
Suffix:
Gender:F
Credentials:LCSW, RN, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:6560 POPLAR AVE
Mailing Address - Street 2:JEWISH FAMILY SERVICE
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3656
Mailing Address - Country:US
Mailing Address - Phone:901-767-8511
Mailing Address - Fax:901-763-2348
Practice Address - Street 1:6560 POPLAR AVE
Practice Address - Street 2:JEWISH FAMILY SERVICE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3656
Practice Address - Country:US
Practice Address - Phone:901-767-8511
Practice Address - Fax:901-763-2348
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000010681041C0700X
TNRN0000025027163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4085965OtherTN BLUE CROSS/BLUE SHIELD
TN3693527Medicare ID - Type UnspecifiedTENNESSEE MEDICARE