Provider Demographics
NPI:1023499720
Name:STARK, NAOMI (LPC)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:STARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 AUER CT STE D
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5828
Mailing Address - Country:US
Mailing Address - Phone:732-390-0007
Mailing Address - Fax:732-390-0017
Practice Address - Street 1:6 AUER CT STE D
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5828
Practice Address - Country:US
Practice Address - Phone:732-390-0007
Practice Address - Fax:732-390-0017
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00246800101Y00000X
NJ37PC00819500101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor