Provider Demographics
NPI:1083947493
Name:PINO, CAPRICE R (MS,LPCC, LADAD)
Entity Type:Individual
Prefix:
First Name:CAPRICE
Middle Name:R
Last Name:PINO
Suffix:
Gender:F
Credentials:MS,LPCC, LADAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 BENTON AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5454
Mailing Address - Country:US
Mailing Address - Phone:505-307-1716
Mailing Address - Fax:
Practice Address - Street 1:4825 BENTON AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5454
Practice Address - Country:US
Practice Address - Phone:505-307-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0131641101YA0400X
NMCTB-2022-0906101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)