Provider Demographics
NPI:1164638086
Name:CAPOZZOLI, KATHRYN DEMARINIS (APRN, BC, PMH)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:DEMARINIS
Last Name:CAPOZZOLI
Suffix:
Gender:F
Credentials:APRN, BC, PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SEVERN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4637
Mailing Address - Country:US
Mailing Address - Phone:410-647-8765
Mailing Address - Fax:
Practice Address - Street 1:4 RIGGS AVE
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146
Practice Address - Country:US
Practice Address - Phone:410-224-2792
Practice Address - Fax:410-263-9593
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR055419364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPN45KDOtherPROVIDER NUMBER, BC