Provider Demographics
NPI:1326119793
Name:CAPEZZA, DIANE R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:R
Last Name:CAPEZZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 MARATHON PKWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2041
Mailing Address - Country:US
Mailing Address - Phone:718-279-7198
Mailing Address - Fax:
Practice Address - Street 1:29 BARSTOW RD
Practice Address - Street 2:SUITE 205
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2209
Practice Address - Country:US
Practice Address - Phone:718-279-7198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0717591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical