Provider Demographics
NPI:1386709350
Name:TEDESCHI, RICHARD GLENN (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GLENN
Last Name:TEDESCHI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1351
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28026-1351
Mailing Address - Country:US
Mailing Address - Phone:704-614-1565
Mailing Address - Fax:704-342-1884
Practice Address - Street 1:236 LEPHILLIP CT
Practice Address - Street 2:SUITE D
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1917
Practice Address - Country:US
Practice Address - Phone:704-342-1812
Practice Address - Fax:704-342-1884
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC605103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2817044AMedicare ID - Type Unspecified