Provider Demographics
NPI:1992871057
Name:STARC, MARIO L (LCSW)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:L
Last Name:STARC
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 COLLEGE AVE STE 216B
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1597
Mailing Address - Country:US
Mailing Address - Phone:510-883-0156
Mailing Address - Fax:
Practice Address - Street 1:5625 COLLEGE AVE STE 216B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1597
Practice Address - Country:US
Practice Address - Phone:510-883-0156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS76791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ97546ZMedicare ID - Type Unspecified