Provider Demographics
NPI:1316213473
Name:CAPUCHINO, IRENE SCHELL (MFT)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:SCHELL
Last Name:CAPUCHINO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:SCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49 NORTH FOURTH STREET
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112
Mailing Address - Country:US
Mailing Address - Phone:408-643-2283
Mailing Address - Fax:
Practice Address - Street 1:49 NORTH FOURTH STREET
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112
Practice Address - Country:US
Practice Address - Phone:408-643-2283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48795106H00000X
CAMFC48795106H00000X
CALPCC 1243101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional