Provider Demographics
NPI:1235770934
Name:STARK, VALERIE ANN
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:STARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5517
Mailing Address - Country:US
Mailing Address - Phone:707-263-5819
Mailing Address - Fax:
Practice Address - Street 1:1510 ARGONAUT RD
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-9361
Practice Address - Country:US
Practice Address - Phone:707-263-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator