Provider Demographics
NPI:1710204755
Name:TALERICO, MICHELE LEE (MSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LEE
Last Name:TALERICO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-0041
Mailing Address - Country:US
Mailing Address - Phone:989-335-5590
Mailing Address - Fax:
Practice Address - Street 1:3500 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:BLACK RIVER
Practice Address - State:MI
Practice Address - Zip Code:48721
Practice Address - Country:US
Practice Address - Phone:248-894-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010896021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty