Provider Demographics
NPI:1902094345
Name:TALLARICO, DEBORAH ANN KNIGHTON (MA, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN KNIGHTON
Last Name:TALLARICO
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 SAWYER RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9143
Mailing Address - Country:US
Mailing Address - Phone:207-653-7823
Mailing Address - Fax:
Practice Address - Street 1:884 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-4371
Practice Address - Country:US
Practice Address - Phone:207-653-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional