Healthcare Provider Details

I. General information

NPI: 1093996910
Provider Name (Legal Business Name): GAIL SANDRA STARR LCSW CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 NORTHLAKE BLVD SUITE 212 IN CARE OF ERE ASSOCIATES
PALM BEACH GARDENS FL
33403-1712
US

IV. Provider business mailing address

7325 SW 63RD AVE SUITE 101 IN CARE OF ERE ASSOCIATES
SOUTH MIAMI FL
33143-4812
US

V. Phone/Fax

Practice location:
  • Phone: 561-626-8070
  • Fax: 561-626-2828
Mailing address:
  • Phone: 305-284-1143
  • Fax: 305-667-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5596
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number20020544
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: