Provider Demographics
NPI:1447405295
Name:JOHN A TALLARIDO P A
Entity Type:Organization
Organization Name:JOHN A TALLARIDO P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TALLARIDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-422-0900
Mailing Address - Street 1:1128 ROYAL PALM BEACH BLVD # 220
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1693
Mailing Address - Country:US
Mailing Address - Phone:561-422-0900
Mailing Address - Fax:
Practice Address - Street 1:1128 ROYAL PALM BEACH BLVD # 220
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1693
Practice Address - Country:US
Practice Address - Phone:561-422-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7234251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2000Medicare UPIN