Provider Demographics
NPI:1174133854
Name:STARBIRD, DOUGLAS BENSON (LADC1)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:BENSON
Last Name:STARBIRD
Suffix:
Gender:M
Credentials:LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 THORNDIKE ST
Mailing Address - Street 2:
Mailing Address - City:DUNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:01827-1415
Mailing Address - Country:US
Mailing Address - Phone:978-302-8578
Mailing Address - Fax:
Practice Address - Street 1:240 THORNDIKE ST
Practice Address - Street 2:
Practice Address - City:DUNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:01827-1415
Practice Address - Country:US
Practice Address - Phone:978-302-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA19260101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health