Provider Demographics
NPI:1265827463
Name:JESSE COLIN CAPECE, LICSW
Entity Type:Organization
Organization Name:JESSE COLIN CAPECE, LICSW
Other - Org Name:JESSE COLIN CAPECE, LICSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:COLIN
Authorized Official - Last Name:CAPECE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-323-0336
Mailing Address - Street 1:81 JENCKES HILL RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4603
Mailing Address - Country:US
Mailing Address - Phone:401-323-0336
Mailing Address - Fax:
Practice Address - Street 1:81 JENCKES HILL ROAD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4603
Practice Address - Country:US
Practice Address - Phone:401-323-0336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW02202101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty