Provider Demographics
NPI:1427136761
Name:STAROSTA, JENNY JANE (PHD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:JANE
Last Name:STAROSTA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:J
Other - Last Name:STAROSTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1079 BARON DR
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1836
Mailing Address - Country:US
Mailing Address - Phone:267-486-2234
Mailing Address - Fax:267-486-2234
Practice Address - Street 1:1079 BARON DR
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1836
Practice Address - Country:US
Practice Address - Phone:267-486-2234
Practice Address - Fax:267-486-2234
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015637103T00000X
NJ35SI00410600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1764635Medicare UPIN
PA097278Medicare ID - Type Unspecified