Provider Demographics
NPI:1710316351
Name:TALESNICK, JACQUELINE CARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:CARA
Last Name:TALESNICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E. BROADWAY P.O. BOX 1126
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-9998
Mailing Address - Country:US
Mailing Address - Phone:818-446-2522
Mailing Address - Fax:516-889-2399
Practice Address - Street 1:2-12 W PARK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2025
Practice Address - Country:US
Practice Address - Phone:516-889-2332
Practice Address - Fax:516-889-2399
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP87850103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist