MEDICARE: LEONARD TEDESCO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	100669	NY

General Provider Information

NPI Number	:	1528550589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD TEDESCO LCSW

Provider Business Mailing Address
First Line	:	5727 S KENTON AVE APT 1S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5318
Country	:	US
Telephone Number	:	773-459-0879
Fax Number	:

Provider Business Practice Location Address
First Line	:	5727 S KENTON AVE APT 1S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5318
Country	:	US
Telephone Number	:	773-459-0879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2018
Last Update Date	:	01/16/2026

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Directions to “ LEONARD TEDESCO LCSW” Practice Location

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