Provider Demographics
NPI:1659863652
Name:TALARICO, JULIA LAUREN
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LAUREN
Last Name:TALARICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BROOK HILL LN APT B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2237
Mailing Address - Country:US
Mailing Address - Phone:585-507-1698
Mailing Address - Fax:
Practice Address - Street 1:131 W BROAD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-1103
Practice Address - Country:US
Practice Address - Phone:585-507-1698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103668-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker