Healthcare Provider Details

I. General information

NPI: 1376770610
Provider Name (Legal Business Name): JOSEPH A TALAMO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2009
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4959 SIMMONS CIR
EXPORT PA
15632-9349
US

IV. Provider business mailing address

4959 SIMMONS CIR
EXPORT PA
15632-9349
US

V. Phone/Fax

Practice location:
  • Phone: 724-989-8210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6779
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number019167
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: