Provider Demographics
NPI:1811160526
Name:STARK, BARBARA L (LMFT)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:L
Last Name:STARK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3074 WHITNEY AVE
Mailing Address - Street 2:BLDG # 1
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2391
Mailing Address - Country:US
Mailing Address - Phone:203-494-3594
Mailing Address - Fax:203-287-2404
Practice Address - Street 1:3074 WHITNEY AVE
Practice Address - Street 2:BLDG # 1
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2391
Practice Address - Country:US
Practice Address - Phone:203-494-3594
Practice Address - Fax:203-287-2404
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000410106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410000410CT01OtherANTHEM BLUE CROSS/BLUE SH