MEDICARE: MRS. MARY PATRICIA AMEDEO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	106H00000X	CO

General Provider Information

NPI Number	:	1144524695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY PATRICIA AMEDEO

Provider Business Mailing Address
First Line	:	2110 ISLAND LN
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-8969
Country	:	US
Telephone Number	:	303-670-3682
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 ISLAND LN
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-8969
Country	:	US
Telephone Number	:	303-670-3682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2010
Last Update Date	:	12/26/2010

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