Provider Demographics
NPI:1548820111
Name:STARACI, VINCENT (LMFT)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:STARACI
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 11TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4107
Mailing Address - Country:US
Mailing Address - Phone:310-458-9500
Mailing Address - Fax:
Practice Address - Street 1:1008 11TH ST STE 301
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4107
Practice Address - Country:US
Practice Address - Phone:310-458-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health