Provider Demographics
NPI:1932308541
Name:STARR, CAROL IRENE (LCSW ACSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:IRENE
Last Name:STARR
Suffix:
Gender:F
Credentials:LCSW ACSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:I
Other - Last Name:STARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW ASCW
Mailing Address - Street 1:413 TEAL ROAD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-2311
Mailing Address - Country:US
Mailing Address - Phone:765-471-8813
Mailing Address - Fax:765-471-8813
Practice Address - Street 1:413 TEAL ROAD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-2311
Practice Address - Country:US
Practice Address - Phone:765-471-8813
Practice Address - Fax:765-471-8813
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000175A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
814760Medicare UPIN