Healthcare Provider Details

I. General information

NPI: 1073918983
Provider Name (Legal Business Name): WENDE WHITING TEDESCO LCSWR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 GROOMS RD STE 2
CLIFTON PARK NY
12065-5912
US

IV. Provider business mailing address

643 GROOMS RD STE 2
CLIFTON PARK NY
12065-5912
US

V. Phone/Fax

Practice location:
  • Phone: 518-982-1274
  • Fax: 518-982-1277
Mailing address:
  • Phone: 518-982-1274
  • Fax: 518-437-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR034156-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: