Provider Demographics
NPI:1033467964
Name:CAPOZZOLI, PASQUALE ANGELO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PASQUALE
Middle Name:ANGELO
Last Name:CAPOZZOLI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:CAPOZZOLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:4301 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-7792
Mailing Address - Fax:239-247-5344
Practice Address - Street 1:4301 VERONICA S SHOEMAKER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-2216
Practice Address - Country:US
Practice Address - Phone:239-274-7792
Practice Address - Fax:239-247-5344
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8575103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist