Healthcare Provider Details

I. General information

NPI: 1619799384
Provider Name (Legal Business Name): EMILY PELHAM TEDESCHI MS.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 LAKES RD
MONROE NY
10950-2613
US

IV. Provider business mailing address

13 BOULEVARD
SUFFERN NY
10901-6245
US

V. Phone/Fax

Practice location:
  • Phone: 718-869-9787
  • Fax:
Mailing address:
  • Phone: 718-869-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberNA
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: