Provider Demographics
NPI:1013011691
Name:CAPOBIANCO, MARIE ELIZABETH (MA, LMHC, LCDP, CCJP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELIZABETH
Last Name:CAPOBIANCO
Suffix:
Gender:F
Credentials:MA, LMHC, LCDP, CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CENTERVILLE RD. AND THE KENT CENTER
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-732-5656
Mailing Address - Fax:
Practice Address - Street 1:300 CENTERVILLE RD. AND THE KENT CENTER
Practice Address - Street 2:SUITE 301
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-732-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC000263101YM0800X
RILCDP00302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health