Provider Demographics
NPI:1184171415
Name:TALBOT, MARY-ANNE
Entity type:Individual
Prefix:
First Name:MARY-ANNE
Middle Name:
Last Name:TALBOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 CAMINO ALIRE
Mailing Address - Street 2:D29
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2346
Mailing Address - Country:US
Mailing Address - Phone:505-603-5887
Mailing Address - Fax:
Practice Address - Street 1:255 CAMINO ALIRE
Practice Address - Street 2:D29
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2346
Practice Address - Country:US
Practice Address - Phone:505-603-5887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst