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General NPI Number Information
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NPI Number | 1447405295
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Entity Type | Organization
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Legal Business Name | JOHN A TALLARIDO P A
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 1128 ROYAL PALM BEACH BLVD # 220
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-1693
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Country | US
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Telephone | 561-422-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 1128 ROYAL PALM BEACH BLVD # 220
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-1693
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Country | US
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Telephone | 561-422-0900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN A TALLARIDO
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Credential | LCSW
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Telephone | 561-422-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SW7234
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License Number State | FL
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