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General NPI Number Information
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NPI Number | 1902094345
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Entity Type | Individual
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Provider Name | DEBORAH ANN KNIGHTON TALLARICO M.A., LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 884 BROADWAY
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-4371
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Country | US
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Telephone | 207-653-7823
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Fax |
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Provider Business Mailing Address
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Address Line | 83 SAWYER RD
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9143
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Country | US
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Telephone | 207-653-7823
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC2680
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License Number State | ME
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