Provider Demographics
NPI:1063606424
Name:CAPPELLO, CARL WILLIAM (DOCTOR OF DIVINITY)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:WILLIAM
Last Name:CAPPELLO
Suffix:
Gender:M
Credentials:DOCTOR OF DIVINITY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7900
Mailing Address - Country:US
Mailing Address - Phone:631-665-6244
Mailing Address - Fax:631-968-6169
Practice Address - Street 1:144 4TH AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7900
Practice Address - Country:US
Practice Address - Phone:631-665-6244
Practice Address - Fax:631-968-6169
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral