Provider Demographics
NPI:1417579046
Name:TELESCO, AMY MICHELLE (MS CLINICAL COUNSELI)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MICHELLE
Last Name:TELESCO
Suffix:
Gender:F
Credentials:MS CLINICAL COUNSELI
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:TELESCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AMY TELESCO
Mailing Address - Street 1:157 SHELTER ROCK RD UNIT 51
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7069
Mailing Address - Country:US
Mailing Address - Phone:914-758-3493
Mailing Address - Fax:
Practice Address - Street 1:100 MILL PLAIN RD FL 3
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5178
Practice Address - Country:US
Practice Address - Phone:203-947-6981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1811350663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional