Healthcare Provider Details

I. General information

NPI: 1437892635
Provider Name (Legal Business Name): TALIA DICHRISTINA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 AURORA ST UPPR
LANCASTER NY
14086-2705
US

IV. Provider business mailing address

149 AURORA ST UPPR
LANCASTER NY
14086-2705
US

V. Phone/Fax

Practice location:
  • Phone: 716-222-1047
  • Fax:
Mailing address:
  • Phone: 716-349-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number094673-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: