Provider Demographics
NPI:1962455048
Name:AMODIO, RICHARD R (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:AMODIO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SPRINGS RD
Mailing Address - Street 2:EDITH NOURSE ROGER VA MEDICAL CENTER
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1114
Mailing Address - Country:US
Mailing Address - Phone:781-687-3056
Mailing Address - Fax:781-687-2169
Practice Address - Street 1:200 SPRINGS RD
Practice Address - Street 2:EDITH NOURSE ROGER VA MEDICAL CENTER
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1114
Practice Address - Country:US
Practice Address - Phone:781-687-3056
Practice Address - Fax:781-687-2169
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6882103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical