Provider Demographics
NPI:1962529651
Name:STARR, BRENDA (RN, LCSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:STARR
Suffix:
Gender:F
Credentials:RN, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 N CYPRESS BEND DR APT 402
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-5602
Mailing Address - Country:US
Mailing Address - Phone:954-629-4779
Mailing Address - Fax:
Practice Address - Street 1:3511 W COMMERCIAL BLVD
Practice Address - Street 2:#206
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309
Practice Address - Country:US
Practice Address - Phone:954-629-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 42841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7188Medicare ID - Type UnspecifiedPROVIDER NUMBER