Provider Demographics
NPI:1598882946
Name:MEDARIS, STARLA JOYCE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STARLA
Middle Name:JOYCE
Last Name:MEDARIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 FREEPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-4347
Mailing Address - Country:US
Mailing Address - Phone:916-393-9753
Mailing Address - Fax:916-552-7940
Practice Address - Street 1:3065 FREEPORT BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-4347
Practice Address - Country:US
Practice Address - Phone:916-393-9753
Practice Address - Fax:916-552-7940
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical