Provider Demographics
NPI:1154335685
Name:TALERICO, LINDA E (FAMILY PSYCHIATRIC M)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:E
Last Name:TALERICO
Suffix:
Gender:F
Credentials:FAMILY PSYCHIATRIC M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 GENESEE ST.
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-3804
Mailing Address - Country:US
Mailing Address - Phone:315-272-2600
Mailing Address - Fax:315-733-8169
Practice Address - Street 1:195-199 WEST DOMINICK STREET
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5855
Practice Address - Country:US
Practice Address - Phone:315-272-2748
Practice Address - Fax:315-272-2740
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304206-1363LG0600X
NY304205363LA2200X
NY401291363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health