Provider Demographics
NPI:1225761695
Name:STARE, NINA (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:STARE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:LASTORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:519 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-2106
Mailing Address - Country:US
Mailing Address - Phone:717-649-1075
Mailing Address - Fax:
Practice Address - Street 1:519 S 29TH ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-2106
Practice Address - Country:US
Practice Address - Phone:223-322-7067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124756104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker