Provider Demographics
NPI:1588960009
Name:CAPUTO, TINA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:CAPUTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 PLUMTREE GRV
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5949
Mailing Address - Country:US
Mailing Address - Phone:630-209-1522
Mailing Address - Fax:
Practice Address - Street 1:2539 PLUMTREE GRV
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5949
Practice Address - Country:US
Practice Address - Phone:630-209-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW-17711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW-1771OtherLCSW