Provider Demographics
NPI:1992931265
Name:CAPACCIOLI, JAN MARIE (LCSW, LAADC, BCD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:MARIE
Last Name:CAPACCIOLI
Suffix:
Gender:F
Credentials:LCSW, LAADC, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 SILER LN
Mailing Address - Street 2:P.O. BOX 7046
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-3133
Mailing Address - Country:US
Mailing Address - Phone:805-623-2203
Mailing Address - Fax:
Practice Address - Street 1:1550 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4819
Practice Address - Country:US
Practice Address - Phone:805-354-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 271451041C0700X
CALCI02970315101YA0400X
NCC0046641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)