| Doctor Name: | MARY AMEDEO |
| NPI Number: | 1124183637 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LICSW |
| License Number: | 212 |
| Business Practice Address: | 129 N Halcyon Rd Arroyo Grande, CA - 934202587 |
| Business Phone Number: | 8052340948 |
| Business Fax Number: | 8447400060 |
| Mailing Address: | 861 Skyline Dr, SAN LUIS OBISPO |
| State: | CA |
| Postal Code: | 934051039 |
| Phone Number: | 8052340948 |
| Fax Number: | 8447400060 |
| NPI Enumeration Date: | 12/26/2006 |
| NPI Last Update Date: | 02/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 212 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |