1154335685 NPI number — MS. LINDA E. TALERICO FAMILY PSYCHIATRIC M

Table of content: MS. LINDA E. TALERICO FAMILY PSYCHIATRIC M (NPI 1154335685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154335685 NPI number — MS. LINDA E. TALERICO FAMILY PSYCHIATRIC M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TALERICO
Provider First Name:
LINDA
Provider Middle Name:
E.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FAMILY PSYCHIATRIC M
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154335685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
293 GENESEE ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UTICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13501-3804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-272-2600
Provider Business Mailing Address Fax Number:
315-733-8169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195-199 WEST DOMINICK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13440-5855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-272-2748
Provider Business Practice Location Address Fax Number:
315-272-2740
Provider Enumeration Date:
07/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  F304206-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 304205 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 401291 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)