Provider Demographics
NPI:1972594000
Name:LIPSCHUTZ, JAN L (MSW)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:L
Last Name:LIPSCHUTZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S BARRINGTON AVE
Mailing Address - Street 2:#307
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5363
Mailing Address - Country:US
Mailing Address - Phone:310-390-5585
Mailing Address - Fax:310-390-9896
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:#307
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5363
Practice Address - Country:US
Practice Address - Phone:310-390-5585
Practice Address - Fax:310-390-9896
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS41711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW4171Medicare ID - Type Unspecified
R65055Medicare UPIN