Provider Demographics
NPI:1346976792
Name:TEDESCO, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:TEDESCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 7TH AVE RM 501
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4850
Mailing Address - Country:US
Mailing Address - Phone:844-415-4592
Mailing Address - Fax:
Practice Address - Street 1:3431 MIRROR LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-3017
Practice Address - Country:US
Practice Address - Phone:740-954-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool