Active NPI
Ruth Prendergast Dennison-Tedesco, PHD
- Professional Counselor
- Ellicott City, MD
National Provider Identifier
1407134067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LC2563
- Practice address
- 3355 Saint Johns LN
St John'S Professional Center Suite F
Ellicott City, MD 21042-2605 - Phone
- (410) 913-4665
- NPI assigned
- Aug 1, 2011
- 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 | LC2563 | MD | Primary |
Addresses
Primary practice location
3355 Saint Johns LN
St John'S Professional Center Suite F
Ellicott City, MD 21042-2605
Mailing address
11745 Old Frederick Rd
Marriottsville, MD 21104-1439
Phone (410) 913-4665
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC2563 | MD | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312156800000",
"number": "1407134067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11745 OLD FREDERICK RD",
"city": "MARRIOTTSVILLE",
"state": "MD",
"postal_code": "211041439",
"telephone_number": "410-913-4665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3355 SAINT JOHNS LN",
"address_2": "ST JOHN'S PROFESSIONAL CENTER SUITE F",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210422605",
"telephone_number": "410-913-4665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DENNISON-TEDESCO",
"first_name": "RUTH",
"middle_name": "PRENDERGAST",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-01",
"last_updated": "2011-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MD",
"license": "LC2563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellicott City, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.