Provider Demographics
NPI:1932867439
Name:STARVISTA
Entity Type:Organization
Organization Name:STARVISTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:650-591-9623
Mailing Address - Street 1:610 ELM ST. #212
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070
Mailing Address - Country:US
Mailing Address - Phone:650-591-9623
Mailing Address - Fax:
Practice Address - Street 1:826 MAHLER RD.
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010
Practice Address - Country:US
Practice Address - Phone:650-689-5597
Practice Address - Fax:650-591-9650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STARVISTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility