Healthcare Provider Details

I. General information

NPI: 1174362727
Provider Name (Legal Business Name): KATHERINE TALERICO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20134 VALLEY FORGE CIR
KING OF PRUSSIA PA
19406-1112
US

IV. Provider business mailing address

20134 VALLEY FORGE CIR
KING OF PRUSSIA PA
19406-1112
US

V. Phone/Fax

Practice location:
  • Phone: 610-878-9330
  • Fax: 267-552-1002
Mailing address:
  • Phone: 610-878-9330
  • Fax: 267-552-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS020460
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: