Provider Demographics
NPI:1164197372
Name:CAPUANO, RYAN KENNETH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:KENNETH
Last Name:CAPUANO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BUDLONG RD APT 2L
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6438
Mailing Address - Country:US
Mailing Address - Phone:401-301-3783
Mailing Address - Fax:
Practice Address - Street 1:469 CENTERVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4355
Practice Address - Country:US
Practice Address - Phone:401-773-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW02590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health