Individual
LISA TEDESCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
99 STAFFORD RD STE B-1, ELLINGTON, CT 06029-2834
(860) 575-6631
Mailing address
208 FLYNN AVE, SUITE 3J, BURLINGTON, VT 05401-5429
(802) 488-6900
(802) 488-6901
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
000347
VT
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
667
CT
Other
Enumeration date
05/13/2010
Last updated
09/29/2021
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