Provider Demographics
NPI:1104488121
Name:TEDESCO, ALYSSA MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:TEDESCO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 WEST ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1140
Mailing Address - Country:US
Mailing Address - Phone:203-718-3121
Mailing Address - Fax:203-756-2521
Practice Address - Street 1:341 WEST ST UNIT B
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1140
Practice Address - Country:US
Practice Address - Phone:203-718-3121
Practice Address - Fax:203-756-2521
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002502106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist