Provider Demographics
NPI:1205686045
Name:STARR, LINDA L
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:STARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-3115
Mailing Address - Country:US
Mailing Address - Phone:860-847-7948
Mailing Address - Fax:860-847-7948
Practice Address - Street 1:1153 MAIN ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-3115
Practice Address - Country:US
Practice Address - Phone:860-847-7948
Practice Address - Fax:860-847-7948
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13030363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health