Provider Demographics
NPI:1154465474
Name:CAPPABIANCA, MARIA LIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LIA
Last Name:CAPPABIANCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 NIEMEYER RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-3237
Mailing Address - Country:US
Mailing Address - Phone:814-440-8384
Mailing Address - Fax:814-455-4146
Practice Address - Street 1:2808 STATE ST STE 100
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1830
Practice Address - Country:US
Practice Address - Phone:814-981-0269
Practice Address - Fax:814-455-4146
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002701101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
251317492OtherVANTAGE