Provider Demographics
NPI:1073135000
Name:TALBOT, JUSTIN (LCSW)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:TALBOT
Suffix:
Gender:X
Credentials:LCSW
Other - Prefix:
Other - First Name:ONDREA
Other - Middle Name:
Other - Last Name:TALBOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1147 N 4TH ST UNIT 3F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1572
Mailing Address - Country:US
Mailing Address - Phone:409-781-0094
Mailing Address - Fax:
Practice Address - Street 1:9800 HILLWOOD PKWY STE 140
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-1532
Practice Address - Country:US
Practice Address - Phone:248-436-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106866104100000X
PASW142208104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker