Provider Demographics
NPI:1710228150
Name:TALBOTT-GREEN, MARLENE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:ANN
Last Name:TALBOTT-GREEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 W SHORT ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3561
Mailing Address - Country:US
Mailing Address - Phone:614-846-8880
Mailing Address - Fax:614-846-8880
Practice Address - Street 1:36 W SHORT ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3561
Practice Address - Country:US
Practice Address - Phone:614-846-8880
Practice Address - Fax:614-846-8880
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000E1490101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional