Provider Demographics
NPI:1699579367
Name:MARTIN, STAR (LCSW)
Entity type:Individual
Prefix:
First Name:STAR
Middle Name:
Last Name:MARTIN
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 OLIVETTE EXECUTIVE PKWY
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3210
Mailing Address - Country:US
Mailing Address - Phone:314-531-1115
Mailing Address - Fax:
Practice Address - Street 1:1155 OLIVETTE EXECUTIVE PKWY
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3210
Practice Address - Country:US
Practice Address - Phone:314-531-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240350281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical