| NPI | 1962042135 |
|---|---|
| Former Name | JENNIFER STARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 87890) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2025-04-01 |