Provider Demographics
NPI:1043411390
Name:CAPASSO, TRACI (MA)
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:
Last Name:CAPASSO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LYON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4926
Mailing Address - Country:US
Mailing Address - Phone:860-523-9788
Mailing Address - Fax:860-232-5049
Practice Address - Street 1:645 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2907
Practice Address - Country:US
Practice Address - Phone:860-523-9788
Practice Address - Fax:860-232-5409
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health