Provider Demographics
NPI:1215124565
Name:CAPOZZI, STACIE (LMHC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:CAPOZZI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 DELAWARE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1009
Mailing Address - Country:US
Mailing Address - Phone:716-882-3151
Mailing Address - Fax:716-886-4022
Practice Address - Street 1:625 DELAWARE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1009
Practice Address - Country:US
Practice Address - Phone:716-882-3151
Practice Address - Fax:716-886-4022
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health