Provider Demographics
NPI:1487446928
Name:TEDESCHI, PHILIP (LCSW)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:TEDESCHI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 PEARL ST STE 308
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5130
Mailing Address - Country:US
Mailing Address - Phone:303-886-4424
Mailing Address - Fax:
Practice Address - Street 1:1035 PEARL ST STE 313
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5130
Practice Address - Country:US
Practice Address - Phone:303-886-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO009910611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical