Provider Demographics
NPI:1114216223
Name:TALICEO, MARCY (MA, LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:TALICEO
Suffix:
Gender:F
Credentials:MA, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3410
Mailing Address - Country:US
Mailing Address - Phone:860-698-6077
Mailing Address - Fax:860-698-6631
Practice Address - Street 1:25 HIGH ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-698-6077
Practice Address - Fax:860-698-6631
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8146101YM0800X
CT2378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008045179Medicaid