Provider Demographics
NPI:1952841538
Name:TEDESCHI, JAN MARIE (LADC-1)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:MARIE
Last Name:TEDESCHI
Suffix:
Gender:F
Credentials:LADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CUMMINGS CTR
Mailing Address - Street 2:SUITE 409T
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6198
Mailing Address - Country:US
Mailing Address - Phone:781-733-1451
Mailing Address - Fax:844-400-3587
Practice Address - Street 1:900 CUMMINGS CTR
Practice Address - Street 2:SUITE 409T
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6198
Practice Address - Country:US
Practice Address - Phone:781-733-1451
Practice Address - Fax:844-400-3587
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2373101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)