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NPI Code Detail

MEDICARE: LISA LAVERNE STARNES

MEDICARE: LISA LAVERNE STARNES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorPT 29845CA

General Provider Information

NPI Number : 1336301118
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA LAVERNE STARNES
Provider Business Mailing Address
First Line : 368 FELL ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94102-5144
Country : US
Telephone Number : 415-861-0828
Fax Number : 415-861-0257
Provider Business Practice Location Address
First Line : 52 DORE ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94103-3828
Country : US
Telephone Number : 415-553-3100
Fax Number : 415-861-0257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2008
Last Update Date : 07/02/2008

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Directions to “ LISA LAVERNE STARNES ” Practice Location

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