Provider Demographics
NPI:1508899360
Name:STARK, HARRY JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:JAMES
Last Name:STARK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20301 VENTURA BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2447
Mailing Address - Country:US
Mailing Address - Phone:818-825-2743
Mailing Address - Fax:818-710-7428
Practice Address - Street 1:20301 VENTURA BLVD STE 309
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2462
Practice Address - Country:US
Practice Address - Phone:818-825-2743
Practice Address - Fax:818-710-7428
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17859103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP 17859 AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER