Provider Demographics
NPI:1881557767
Name:TALLYEN, JESSE (LMSW, LCDP, CADC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:TALLYEN
Suffix:
Gender:M
Credentials:LMSW, LCDP, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-1731
Mailing Address - Country:US
Mailing Address - Phone:302-569-5114
Mailing Address - Fax:
Practice Address - Street 1:529 COOPER ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-1731
Practice Address - Country:US
Practice Address - Phone:302-569-5114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-08
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ3-0011153104100000X
DECD-0010151101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty