Provider Demographics
NPI:1770612293
Name:STARK, SHERISE NATALIA (MSW, PPS, LCSW)
Entity type:Individual
Prefix:MS
First Name:SHERISE
Middle Name:NATALIA
Last Name:STARK
Suffix:
Gender:
Credentials:MSW, PPS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8770 HARBISON CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-2615
Mailing Address - Country:US
Mailing Address - Phone:619-445-2977
Mailing Address - Fax:
Practice Address - Street 1:8770 HARBISON CANYON RD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-2615
Practice Address - Country:US
Practice Address - Phone:619-445-2977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284291041C0700X
CA156181041C0700X
CA1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical