Provider Demographics
NPI:1487719746
Name:TEDALDI, KIM M (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:M
Last Name:TEDALDI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LOTHROP LN
Mailing Address - Street 2:
Mailing Address - City:TIVOLI
Mailing Address - State:NY
Mailing Address - Zip Code:12583-5414
Mailing Address - Country:US
Mailing Address - Phone:845-757-2707
Mailing Address - Fax:
Practice Address - Street 1:10 LOTHROP LN
Practice Address - Street 2:
Practice Address - City:TIVOLI
Practice Address - State:NY
Practice Address - Zip Code:12583-5414
Practice Address - Country:US
Practice Address - Phone:845-757-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0797251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical