Provider Demographics
NPI:1104154350
Name:STARK, BARBARA PEARL (PSYD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:PEARL
Last Name:STARK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 WILSHIRE BLVD
Mailing Address - Street 2:710
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1809
Mailing Address - Country:US
Mailing Address - Phone:805-452-6479
Mailing Address - Fax:310-394-8930
Practice Address - Street 1:1247 10TH ST
Practice Address - Street 2:4
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1944
Practice Address - Country:US
Practice Address - Phone:310-394-1095
Practice Address - Fax:310-394-8930
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12764103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical