Provider Demographics
NPI:1154327641
Name:CAPUTY, VIRGINIA J (LCSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:J
Last Name:CAPUTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:J
Other - Last Name:CLIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSA
Mailing Address - Street 1:321 W PROMENADE ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265
Mailing Address - Country:US
Mailing Address - Phone:573-582-1234
Mailing Address - Fax:573-582-1212
Practice Address - Street 1:321 W PROMENADE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265
Practice Address - Country:US
Practice Address - Phone:573-582-1234
Practice Address - Fax:573-582-1212
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010153931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495358301Medicaid
MO000078759Medicare ID - Type Unspecified