Provider Demographics
NPI:1093996910
Name:STARR, GAIL SANDRA (LCSW CDE)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:SANDRA
Last Name:STARR
Suffix:
Gender:F
Credentials:LCSW CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 SW 63RD AVE
Mailing Address - Street 2:SUITE 101 IN CARE OF ERE ASSOCIATES
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4812
Mailing Address - Country:US
Mailing Address - Phone:305-284-1143
Mailing Address - Fax:305-667-9880
Practice Address - Street 1:3450 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 212 IN CARE OF ERE ASSOCIATES
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1712
Practice Address - Country:US
Practice Address - Phone:561-626-8070
Practice Address - Fax:561-626-2828
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW55961041C0700X
FL20020544133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ083WOtherBCBS FLORIDA