Provider Demographics
NPI:1629324876
Name:STARKS, MICHAEL JOSEPH (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:STARKS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7071 BOSTON STATE RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-6610
Mailing Address - Country:US
Mailing Address - Phone:716-563-1633
Mailing Address - Fax:888-910-2313
Practice Address - Street 1:7071 BOSTON STATE RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-6610
Practice Address - Country:US
Practice Address - Phone:716-563-1633
Practice Address - Fax:888-910-2313
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089182-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker