Provider Demographics
NPI:1154532893
Name:STARBIRD, CAROLYN JANE (PHD)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:JANE
Last Name:STARBIRD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1501
Mailing Address - Country:US
Mailing Address - Phone:503-493-1221
Mailing Address - Fax:503-827-3917
Practice Address - Street 1:1923 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1501
Practice Address - Country:US
Practice Address - Phone:503-493-1221
Practice Address - Fax:503-827-3917
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1233103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR108002Medicare PIN