Healthcare Provider Details

I. General information

NPI: 1285271791
Provider Name (Legal Business Name): CARLA STARR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date: 04/04/2022
Reactivation Date: 07/13/2022

III. Provider practice location address

963 LONEMAN CT
OGLALA SD
57764-3076
US

IV. Provider business mailing address

PO BOX 568
OGLALA SD
57764-0568
US

V. Phone/Fax

Practice location:
  • Phone: 716-864-4726
  • Fax:
Mailing address:
  • Phone: 716-864-4726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5242
License Number StateSD

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: