Healthcare Provider Details

I. General information

NPI: 1023481215
Provider Name (Legal Business Name): STARR HALL MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 OAKFIELD DR STE 102
BRANDON FL
33511-3893
US

IV. Provider business mailing address

614 BARKFIELD LOOP
BRANDON FL
33511-7122
US

V. Phone/Fax

Practice location:
  • Phone: 813-489-4547
  • Fax:
Mailing address:
  • Phone: 813-610-8285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: