Provider Demographics
NPI:1417017161
Name:CAPOOTH, ROSEANNA (PHD)
Entity Type:Individual
Prefix:
First Name:ROSEANNA
Middle Name:
Last Name:CAPOOTH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 OAKLEAF OFFICE LN STE 2
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4819
Mailing Address - Country:US
Mailing Address - Phone:901-371-0018
Mailing Address - Fax:901-373-9613
Practice Address - Street 1:641 OAKLEAF OFFICE LN STE 2
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4819
Practice Address - Country:US
Practice Address - Phone:901-371-0018
Practice Address - Fax:901-373-9613
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical