Kim M Tedaldi, LMSW
Individual provider Active NPI Clinical Social Worker · Tivoli, NY
NPI 1487719746 · NPPES record last updated Mar 4, 2011
Key facts
- NPI
- 1487719746
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 079725 (NY)
- Practice address
- 10 Lothrop LN
Tivoli, NY 12583-5414 - Phone
- (845) 757-2707
- NPI assigned
- Dec 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190730000280 | NY | Practitioner - Clinical Social Worker | 0941536940 | Practice locations: Tivoli, NY |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 088271 | NY | MD | Social Worker |
| 079725 | NY | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 079725 | NY | Yes |
Addresses
Primary practice location
10 Lothrop LN
Tivoli, NY 12583-5414
Mailing address
10 Lothrop LN
Tivoli, NY 12583-5414
Phone (845) 757-2707
Other providers in Tivoli, NY
- Ronnie Organ
- Karin Sorg
- Leo Stronger
- Nydia Esther Sturges
- Jill Snyder Taylor
- William Teubl
- Elsa Byatt Votava
- Nacia Karim Walsh
- Kellie Alyse Warning
- Grace Anne Weisbecker
All providers in Tivoli, NY · Clinical Social Worker in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.