Provider Demographics
NPI:1710447743
Name:TALLICHET, RENE WILLIAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:WILLIAM
Last Name:TALLICHET
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 SPRINGFORD DR APT G10
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-4847
Mailing Address - Country:US
Mailing Address - Phone:814-883-6034
Mailing Address - Fax:
Practice Address - Street 1:6115 SPRINGFORD DR APT G10
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-4847
Practice Address - Country:US
Practice Address - Phone:814-883-6034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005579L103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty