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General NPI Number Information
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NPI Number | 1710447743
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Entity Type | Individual
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Provider Name | RENE WILLIAM TALLICHET PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 6115 SPRINGFORD DR APT G10
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City | HARRISBURG
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State | PA
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Zip | 17111-4847
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Country | US
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Telephone | 814-883-6034
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Fax |
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Provider Business Mailing Address
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Address Line | 6115 SPRINGFORD DR APT G10
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City | HARRISBURG
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State | PA
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Zip | 17111-4847
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Country | US
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Telephone | 814-883-6034
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | PS005579L
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License Number State | PA
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