Healthcare Provider Details

I. General information

NPI: 1992879027
Provider Name (Legal Business Name): JEANETTE ANN TEDESCO R.N., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 11/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 THOMASTON AVE BLDG 2 SUITE 10-12
WATERBURY CT
06704-1731
US

IV. Provider business mailing address

1215 THOMASTON AVE BLDG 2 SUITE 10-12
WATERBURY CT
06704-1731
US

V. Phone/Fax

Practice location:
  • Phone: 203-753-0868
  • Fax: 203-753-0860
Mailing address:
  • Phone: 203-753-0868
  • Fax: 203-753-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000091
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: