Provider Demographics
NPI:1528238698
Name:TALLENT, KATHLEEN ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANNE
Last Name:TALLENT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35 DUKE ST UNIT 763
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-7528
Mailing Address - Country:US
Mailing Address - Phone:443-295-8955
Mailing Address - Fax:888-883-1589
Practice Address - Street 1:65 DUKE ST STE 203
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-6128
Practice Address - Country:US
Practice Address - Phone:443-295-8955
Practice Address - Fax:888-883-1589
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04363103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist