Provider Demographics
NPI:1942625470
Name:AMEDURI, PAUL J (MS, CMHC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:AMEDURI
Suffix:
Gender:M
Credentials:MS, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 SHATTUCK WAY
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7868
Mailing Address - Country:US
Mailing Address - Phone:603-436-0448
Mailing Address - Fax:
Practice Address - Street 1:2301 YALE BLVD SE BLDG F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4228
Practice Address - Country:US
Practice Address - Phone:505-272-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator