Provider Demographics
NPI:1184008997
Name:TALLERICO, JANET (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:TALLERICO
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 PERRY HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8379
Mailing Address - Country:US
Mailing Address - Phone:724-933-4673
Mailing Address - Fax:724-799-8365
Practice Address - Street 1:12300 PERRY HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8379
Practice Address - Country:US
Practice Address - Phone:724-933-4673
Practice Address - Fax:724-799-8365
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-15-18753103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst