Provider Demographics
NPI:1932677564
Name:CALDWELL, STARR GOBERT (LCSW)
Entity type:Individual
Prefix:
First Name:STARR
Middle Name:GOBERT
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 COUNTRY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-9286
Mailing Address - Country:US
Mailing Address - Phone:270-699-1542
Mailing Address - Fax:
Practice Address - Street 1:114 N SPALDING AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1517
Practice Address - Country:US
Practice Address - Phone:270-699-1567
Practice Address - Fax:502-331-6062
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4299682OtherWELLCARE
KYPDZ000000317963OtherAETNA BETTER HEALTH
KY7100564230Medicaid