Provider Demographics
NPI:1992967004
Name:STARR, STEPHANIE MANN (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MANN
Last Name:STARR
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 1:107 PINEHURST LANE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-3916
Mailing Address - Country:US
Mailing Address - Phone:561-391-9640
Mailing Address - Fax:
Practice Address - Street 1:107 PINEHURST LANE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-3916
Practice Address - Country:US
Practice Address - Phone:561-391-9640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW52891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical