Provider Demographics
NPI:1174667026
Name:CAPOLUPO, ARIONE D (MFT)
Entity Type:Individual
Prefix:
First Name:ARIONE
Middle Name:D
Last Name:CAPOLUPO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25885 TRABUCO RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-6602
Mailing Address - Country:US
Mailing Address - Phone:714-437-7400
Mailing Address - Fax:714-437-7410
Practice Address - Street 1:275 CENTENNIAL WAY
Practice Address - Street 2:SUITE 107
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3708
Practice Address - Country:US
Practice Address - Phone:714-437-7400
Practice Address - Fax:714-437-7410
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39729106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC39729OtherSTATE LICENSE