Provider Demographics
NPI:1619100898
Name:TALBERT, CRISTA ANN (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:CRISTA
Middle Name:ANN
Last Name:TALBERT
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 CYPRESS BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4213
Mailing Address - Country:US
Mailing Address - Phone:410-544-1671
Mailing Address - Fax:
Practice Address - Street 1:802 CYPRESS BEACH RD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4213
Practice Address - Country:US
Practice Address - Phone:410-544-1671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD499188OtherVO-MHA
MD609550002Medicaid