Provider Demographics
NPI:1497201321
Name:STARK GAUSE, PAULA
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:STARK GAUSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:STARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9370 SW 181ST TER
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5763
Mailing Address - Country:US
Mailing Address - Phone:786-359-3915
Mailing Address - Fax:
Practice Address - Street 1:9370 SW 181ST TER
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5763
Practice Address - Country:US
Practice Address - Phone:786-359-3915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-19-35329103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019295900Medicaid