Provider Demographics
NPI:1902854284
Name:TALIAFERRO, JAMES A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:TALIAFERRO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4595 CLEARVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4503
Mailing Address - Country:US
Mailing Address - Phone:801-998-8119
Mailing Address - Fax:
Practice Address - Street 1:44 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1105
Practice Address - Country:US
Practice Address - Phone:801-584-8512
Practice Address - Fax:801-584-8579
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140436-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical