Eleanor Theresa Tedesco, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

87398 Issued in SC

Practice address

3922 Glenmere Dr
Myrtle Beach, SC 29588-6769

Phone

(508) 769-2364

Fax

(843) 668-2468

NPI assigned

Jan 23, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA, SC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Psychiatry

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Supportive Behavioral Care of Ma LLCGroup PAC ID 8628346731, 103 clinicians

Charleston Counseling Center PCGroup PAC ID 6204125107, 186 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.eleanortedesco@149035.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Charleston Counseling Center PC

  • Mental Health Counselor
  • Mount Pleasant, SC
  • NPI 1316375678
  Medicare reassignment Care Compare group NPD
• Supportive Behavioral Care of Ma LLC

  • Clinical Psychologist
  • Needham, MA
  • NPI 1780115519
  Medicare reassignment Care Compare group NPD
• Supportive Care of South Carolina LLC

  • Clinical Psychologist
  • Mt Pleasant, SC
  • NPI 1417681412
  Medicare reassignment NPD
• Boston Neurobehavioral Associates, LLC

  • Psychiatry Physician
  • New Bedford, MA
  • NPI 1558415307
  Medicare reassignment NPD
• Community Health Connections, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fitchburg, MA
  • NPI 1477580827
  Medicare reassignment NPD
• Steward Medical Group, Inc

  • Specialist
  • Watertown, MA
  • NPI 1629398219
  Medicare reassignment NPD
• Tedesco Medical Associates, LLC

  • Psychiatry Physician
  • Worcester, MA
  • NPI 1073990958
  NPD (past) Authorized official
• Myrtle Beach Counseling Center

  • Mental Health Counselor
  • Myrtle Beach, SC
  • NPI 1235784661
  NPD
• Community Health Connections, Inc.

  • Federally Qualified Health Center (FQHC)
  • Gardner, MA
  • NPI 1225742174
  NPD
• Community Health Connections, Inc.

  • Federally Qualified Health Center (FQHC)
  • Gardner, MA
  • NPI 1285630533
  NPD
• Steward Medical Group, Inc

  • Specialist
  • Brighton, MA
  • NPI 1356654495
  NPD
• Excalibur Youth Services, LLC.

  • Psychiatric Residential Treatment Facility
  • Simpsonville, SC
  • NPI 1083852511
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1700930914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3922 GLENMERE DR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295886769",
            "telephone_number": "508-769-2364",
            "fax_number": "843-668-2468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3922 GLENMERE DR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295886769",
            "telephone_number": "508-769-2364",
            "fax_number": "843-668-2468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDESCO",
        "first_name": "ELEANOR",
        "middle_name": "THERESA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "152283",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "87398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3178111",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthoni J Taylor
• David Edward Taylor, MAC. M.PAC, ADC-IP
• Kelly Taylor
• Tara Alesia Taylor, MA, LPC
• Bernard Richard Tedesco, LPC
• Megan A Teeters, PT
• Tempe Anne Oehler, LCSW, Acsw, PA
• Noelle Kristen Terrana
• Wendy Testa, LMT
• Sweta Jha Thakur, MD

• Psychiatry Physician in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Psychiatry Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.