MEDICARE: GINA TALERICO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-23-68858
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1063154318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA TALERICO

Provider Business Mailing Address
First Line	:	2736 MEDINA RD STE 108
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-9801
Country	:	US
Telephone Number	:	330-952-0403
Fax Number	:

Provider Business Practice Location Address
First Line	:	2736 MEDINA RD STE 108
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-9801
Country	:	US
Telephone Number	:	330-952-0403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2022
Last Update Date	:	11/22/2023

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Directions to “ GINA TALERICO ” Practice Location

Language	Start Address	Practice Location

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