Provider Demographics
NPI:1225899941
Name:CAPONIGRO, SUPRANEE
Entity Type:Individual
Prefix:MRS
First Name:SUPRANEE
Middle Name:
Last Name:CAPONIGRO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUPRANEE
Other - Middle Name:
Other - Last Name:KOSINSUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 ANDRE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST FREETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02717-1218
Mailing Address - Country:US
Mailing Address - Phone:774-225-9834
Mailing Address - Fax:
Practice Address - Street 1:80 WASHINGTON ST STE P55
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1742
Practice Address - Country:US
Practice Address - Phone:781-290-3886
Practice Address - Fax:781-836-5006
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARBT-23-292873106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician