Provider Demographics
NPI:1861834319
Name:STARK, ANSLIE MERLE (PSYD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:ANSLIE
Middle Name:MERLE
Last Name:STARK
Suffix:
Gender:F
Credentials:PSYD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19390 COLLINS AVE PH 21
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2200
Mailing Address - Country:US
Mailing Address - Phone:305-933-8647
Mailing Address - Fax:
Practice Address - Street 1:3300 PGA BLVD STE 310
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2810
Practice Address - Country:US
Practice Address - Phone:561-983-6645
Practice Address - Fax:954-277-2704
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6421101YM0800X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist