Provider Demographics
NPI:1053323014
Name:AMODEI, NANCY (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:AMODEI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 MEDICAL DR STE 7100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5397
Mailing Address - Country:US
Mailing Address - Phone:210-342-1906
Mailing Address - Fax:210-570-8203
Practice Address - Street 1:4242 MEDICAL DR STE 7100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5397
Practice Address - Country:US
Practice Address - Phone:210-342-1906
Practice Address - Fax:210-570-8203
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23754103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035550502Medicaid
TX035550501Medicaid