Individual
JONATHAN MARK LIPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2129
CO
103TH0100X
Health Service Psychologist
2129
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07021298
—
CO
01
—
LIA53624
BLUE CROSS BLUE SHIELD
—
Enumeration date
08/12/2005
Last updated
06/11/2009
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