Basic Information
| Provider Information | |||||||||
| NPI: | 1851421127 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIPOFF | ||||||||
| FirstName: | VICTORIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1408 BEAUMONT DR | ||||||||
| Address2: | |||||||||
| City: | GLADWYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190351304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105201510 | ||||||||
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| Practice Location | |||||||||
| Address1: | 850 W LANCASTER AVE | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190103224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105201510 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW123936 | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.