Active NPI
Kelly M Tedesco, LPC
- Professional Counselor
- Short Hills, NJ
National Provider Identifier
1336874163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 37PC00920600
- Practice address
- 830 Morris Tpke Ste 405
Short Hills, NJ 07078-2620 - Phone
- (862) 206-6861
- NPI assigned
- Jul 17, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 37PC00920600 | NJ | Primary |
Addresses
Primary practice location
830 Morris Tpke Ste 405
Short Hills, NJ 07078-2620
Mailing address
347 Lincoln Ave E Ste 2B
Cranford, NJ 07016-6100
Phone (862) 206-6861
Other practice location 1
347 Lincoln Ave E Ste 2B
Cranford, NJ 07016-6100
Phone (862) 206-6861
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 17, 2025 through Mar 17, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37PC00920600 | NJ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709942400000",
"number": "1336874163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "347 LINCOLN AVE E STE 2B",
"city": "CRANFORD",
"state": "NJ",
"postal_code": "070166100",
"telephone_number": "862-206-6861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 MORRIS TPKE STE 405",
"city": "SHORT HILLS",
"state": "NJ",
"postal_code": "070782620",
"telephone_number": "862-206-6861"
}
],
"practiceLocations": [
{
"address_1": "347 Lincoln Ave E Ste 2B",
"address_purpose": "LOCATION",
"city": "Cranford",
"state": "NJ",
"postal_code": "070166100",
"country_code": "US",
"telephone_number": "862-206-6861",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TEDESCO",
"first_name": "KELLY",
"middle_name": "M",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-17",
"last_updated": "2024-03-09",
"certification_date": "2024-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NJ",
"license": "37PC00920600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Short Hills, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.