Provider Demographics
NPI:1043323025
Name:STARKES, MARY ANN (BSN,MSN,APRN,BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:STARKES
Suffix:
Gender:F
Credentials:BSN,MSN,APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3074 WHITNEY AVE
Mailing Address - Street 2:BUILDING ONE
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2391
Mailing Address - Country:US
Mailing Address - Phone:203-248-9110
Mailing Address - Fax:203-287-2404
Practice Address - Street 1:3074 WHITNEY AVE
Practice Address - Street 2:BUILDING ONE
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2391
Practice Address - Country:US
Practice Address - Phone:203-248-9110
Practice Address - Fax:203-287-2404
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001795363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6249561OtherUNITED BEHAVIORAL HEALTH
CT400001795CT02OtherANTHEM BLUE CROSS/BLUE SH
CT477390000OtherMAGELLAN
CT7717126OtherAETNA
CTP33820Medicare UPIN
CT6249561OtherUNITED BEHAVIORAL HEALTH