Provider Demographics
NPI:1306689005
Name:TALARICO, MIA (LSW)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:TALARICO
Suffix:
Gender:X
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3205
Mailing Address - Country:US
Mailing Address - Phone:973-323-3446
Mailing Address - Fax:
Practice Address - Street 1:395 S CENTER ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3205
Practice Address - Country:US
Practice Address - Phone:973-323-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06964700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker