Provider Demographics
NPI:1306285143
Name:CAPOBIANCO, MARIE AMELIA (MA, CAGS, LCMHC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:AMELIA
Last Name:CAPOBIANCO
Suffix:
Gender:F
Credentials:MA, CAGS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 GEORGE ARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4845
Mailing Address - Country:US
Mailing Address - Phone:401-921-5193
Mailing Address - Fax:401-751-1378
Practice Address - Street 1:160 GEORGE ARDEN AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4845
Practice Address - Country:US
Practice Address - Phone:401-921-5193
Practice Address - Fax:401-751-1378
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00575101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health