Provider Demographics
NPI:1245322478
Name:TALERICO, GINGER MARIE
Entity type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:MARIE
Last Name:TALERICO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GINGER
Other - Middle Name:MARIE
Other - Last Name:FORBES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:9030 58TH DR E
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6108
Mailing Address - Country:US
Mailing Address - Phone:941-228-5144
Mailing Address - Fax:
Practice Address - Street 1:9030 58TH DR E
Practice Address - Street 2:SUITE 103
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-6108
Practice Address - Country:US
Practice Address - Phone:941-228-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8857101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768291300Medicaid
FL767948300Medicaid