Provider Demographics
NPI:1801305982
Name:AMODEO, NANNETTE FLORIN (MA, LPC)
Entity type:Individual
Prefix:
First Name:NANNETTE
Middle Name:FLORIN
Last Name:AMODEO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:NANNETTE
Other - Middle Name:MICHELLE
Other - Last Name:FLORIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7035 DARK HORSE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1438
Mailing Address - Country:US
Mailing Address - Phone:719-313-3936
Mailing Address - Fax:
Practice Address - Street 1:1824 WOODMOOR DR STE 101
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9097
Practice Address - Country:US
Practice Address - Phone:719-445-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014399101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000167097Medicaid