Provider Demographics
NPI:1700103801
Name:TALLARICO, KATIA AURORA (KATIA TALLARICO)
Entity Type:Individual
Prefix:
First Name:KATIA
Middle Name:AURORA
Last Name:TALLARICO
Suffix:
Gender:F
Credentials:KATIA TALLARICO
Other - Prefix:
Other - First Name:KATIA
Other - Middle Name:
Other - Last Name:TALLARICO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, EDM, LMHC
Mailing Address - Street 1:38 W 31ST ST
Mailing Address - Street 2:APT139
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4403
Mailing Address - Country:US
Mailing Address - Phone:917-667-5683
Mailing Address - Fax:
Practice Address - Street 1:116 JOHN ST
Practice Address - Street 2:27TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3300
Practice Address - Country:US
Practice Address - Phone:212-385-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004362-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health