=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629324876
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL JOSEPH STARKS LMSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2012
-----------------------------------------------------
Last Update Date | 03/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7071 BOSTON STATE RD
-----------------------------------------------------
City | HAMBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14075-6610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-563-1633
-----------------------------------------------------
Fax | 888-910-2313
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7071 BOSTON STATE RD
-----------------------------------------------------
City | HAMBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14075-6610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-563-1633
-----------------------------------------------------
Fax | 888-910-2313
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 089182-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------