Provider Demographics
NPI:1063520369
Name:CAPALDO, THEODORA F (EDD)
Entity type:Individual
Prefix:DR
First Name:THEODORA
Middle Name:F
Last Name:CAPALDO
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WEST ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01833-1326
Mailing Address - Country:US
Mailing Address - Phone:978-352-8175
Mailing Address - Fax:978-352-4056
Practice Address - Street 1:111 WEST ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:MA
Practice Address - Zip Code:01833-1326
Practice Address - Country:US
Practice Address - Phone:978-352-8175
Practice Address - Fax:978-352-4056
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2638103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0508411Medicaid
MAWO2694Medicare ID - Type Unspecified