Provider Demographics
NPI:1467216937
Name:TALLURI, SWETHA (LPC)
Entity Type:Individual
Prefix:
First Name:SWETHA
Middle Name:
Last Name:TALLURI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7443
Mailing Address - Country:US
Mailing Address - Phone:732-272-0127
Mailing Address - Fax:
Practice Address - Street 1:100 S BROAD STREET, STE. 1700
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110
Practice Address - Country:US
Practice Address - Phone:732-272-0127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional