Healthcare Provider Details

I. General information

NPI: 1780948182
Provider Name (Legal Business Name): MARTIN STARR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 MARTIN LUTHER KING JR BLVD
EUGENE OR
97401-5824
US

IV. Provider business mailing address

2411 MARTIN LUTHER KING JR BLVD
EUGENE OR
97401-5824
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-3608
  • Fax: 541-682-3276
Mailing address:
  • Phone: 541-682-3608
  • Fax: 541-682-3276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL2469
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: