Provider Demographics
NPI:1992879027
Name:TEDESCO, JEANETTE ANN (RN, PHD)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:ANN
Last Name:TEDESCO
Suffix:
Gender:F
Credentials:RN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 THOMASTON AVE
Mailing Address - Street 2:BLDG 2 SUITE 10-12
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-1731
Mailing Address - Country:US
Mailing Address - Phone:203-753-0868
Mailing Address - Fax:203-753-0860
Practice Address - Street 1:1215 THOMASTON AVE
Practice Address - Street 2:BLDG 2 SUITE 10-12
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-1731
Practice Address - Country:US
Practice Address - Phone:203-753-0868
Practice Address - Fax:203-753-0860
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional