Provider Demographics
NPI:1447407937
Name:STAROSKY, MICHELLE DIANE (MS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIANE
Last Name:STAROSKY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:DIANE
Other - Last Name:STAROSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:15-2700 MOANO ST
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-9025
Mailing Address - Country:US
Mailing Address - Phone:808-965-0450
Mailing Address - Fax:
Practice Address - Street 1:14-803 SEAVIEW RD
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778
Practice Address - Country:US
Practice Address - Phone:808-756-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 41962101YM0800X
HI290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health