Provider Demographics
NPI:1992884191
Name:LIPPER, MARILYN REYNOLDS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:REYNOLDS
Last Name:LIPPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 GREENWOOD ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:BARNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30204-1554
Mailing Address - Country:US
Mailing Address - Phone:770-789-2238
Mailing Address - Fax:770-229-2015
Practice Address - Street 1:522 GREENWOOD ST
Practice Address - Street 2:SUITE G
Practice Address - City:BARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30204-1554
Practice Address - Country:US
Practice Address - Phone:770-789-2238
Practice Address - Fax:770-229-2015
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0026681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical