Provider Demographics
NPI:1053409656
Name:S.T.A.R. SEXUAL TRAUMA AND RECOVERY INC.
Entity type:Organization
Organization Name:S.T.A.R. SEXUAL TRAUMA AND RECOVERY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HANSON
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:610-658-2737
Mailing Address - Street 1:300 E LANCASTER AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2139
Mailing Address - Country:US
Mailing Address - Phone:610-658-2737
Mailing Address - Fax:610-658-2739
Practice Address - Street 1:300 E LANCASTER AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2139
Practice Address - Country:US
Practice Address - Phone:610-658-2737
Practice Address - Fax:610-658-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA234321101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty