Provider Demographics
NPI:1235332347
Name:CAPPELLO, VINCENT ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:ANTHONY
Last Name:CAPPELLO
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 1:608 G ST # 1
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-3738
Mailing Address - Country:US
Mailing Address - Phone:707-954-1109
Mailing Address - Fax:
Practice Address - Street 1:608 G ST # 1
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-3738
Practice Address - Country:US
Practice Address - Phone:707-954-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical