Provider Demographics
NPI:1699713180
Name:CAPODILUPO, SHONNY L (LCSW)
Entity type:Individual
Prefix:
First Name:SHONNY
Middle Name:L
Last Name:CAPODILUPO
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 1:6 WOODCREEK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1013
Mailing Address - Country:US
Mailing Address - Phone:203-740-0583
Mailing Address - Fax:
Practice Address - Street 1:1 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-3003
Practice Address - Country:US
Practice Address - Phone:914-872-5265
Practice Address - Fax:914-289-0566
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0730221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN237V1Medicare ID - Type UnspecifiedPROVIDER ID #