Active NPI
John Amodeo, MFT
- Marriage & Family Therapist
- San Rafael, CA
National Provider Identifier
1093177651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC14453
- Practice address
- 1368 Lincoln Ave
Suite 212
San Rafael, CA 94901-2147 - Phone
- (707) 829-8948
- NPI assigned
- Mar 23, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC14453 | CA | Primary |
Addresses
Primary practice location
1368 Lincoln Ave
Suite 212
San Rafael, CA 94901-2147
Mailing address
1368 Lincoln Ave
Suite 212
San Rafael, CA 94901-2147
Phone (707) 829-8948
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC14453 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458691200000",
"number": "1093177651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1368 LINCOLN AVE",
"address_2": "SUITE 212",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949012147",
"telephone_number": "707-829-8948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1368 LINCOLN AVE",
"address_2": "SUITE 212",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949012147",
"telephone_number": "707-829-8948"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMODEO",
"first_name": "JOHN",
"name_prefix": "Dr.",
"credential": "MFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-03-23",
"last_updated": "2016-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC14453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.