Basic Information
| Provider Information | |||||||||
| NPI: | 1093991663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIPPERT | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3020 CHILDREN'S WAY | ||||||||
| Address2: | MC 5018 RADY CHILDREN'S HOSPITAL; OUTPATIENT PSYCHIATRY | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921234282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197585993 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5454 EL CAJON BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921153621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195152400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2008 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS22526 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.