Provider Demographics
NPI:1003276486
Name:STARCK, ALYSSA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:STARCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2057 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3847
Mailing Address - Country:US
Mailing Address - Phone:414-643-8778
Mailing Address - Fax:
Practice Address - Street 1:2057 S 14TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3847
Practice Address - Country:US
Practice Address - Phone:414-643-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical