Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | LCS17604 | CA |
Y | 1041C0700X | Clinical Social Worker | X-06263 | NM |
NPI | 1003053760 |
---|---|
Provider Name | Ms. Patricia Ann Stark |
First Address | Santa Fe, NM 87505-7615 |
Second Address | Santa Fe, NM 87505-7615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2009 |
Last Update Date | 26/09/2011 |