MEDICARE: DR. KATHLEEN ANNE TALLENT PH.D

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	103T00000X	Psychologist	04363	MD

General Provider Information

NPI Number	:	1528238698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN ANNE TALLENT PH.D

Provider Business Mailing Address
First Line	:	35 DUKE ST UNIT 763
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-7528
Country	:	US
Telephone Number	:	443-295-8955
Fax Number	:	888-883-1589

Provider Business Practice Location Address
First Line	:	65 DUKE ST STE 203
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-6128
Country	:	US
Telephone Number	:	443-295-8955
Fax Number	:	888-883-1589

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

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	08/08/2021

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