Provider Demographics
NPI:1356708697
Name:TALIA DIPIETRO LLC
Entity type:Organization
Organization Name:TALIA DIPIETRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TALIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DIPIETRO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:929-400-7783
Mailing Address - Street 1:2448 ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2504
Mailing Address - Country:US
Mailing Address - Phone:929-400-7783
Mailing Address - Fax:917-382-2235
Practice Address - Street 1:255 S 17TH ST
Practice Address - Street 2:SUITE 1601
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6231
Practice Address - Country:US
Practice Address - Phone:929-400-7783
Practice Address - Fax:917-382-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0815211041C0700X
PACW0188611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty