Provider Demographics
NPI:1447392501
Name:CAPPELLI, CAGNEY DAMIEN (MA,LCPC,CADC,MISA II)
Entity Type:Individual
Prefix:MR
First Name:CAGNEY
Middle Name:DAMIEN
Last Name:CAPPELLI
Suffix:
Gender:M
Credentials:MA,LCPC,CADC,MISA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 REBECCA CIR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-5000
Mailing Address - Country:US
Mailing Address - Phone:815-999-2552
Mailing Address - Fax:
Practice Address - Street 1:54 N OTTAWA ST
Practice Address - Street 2:SUITE 500
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-4345
Practice Address - Country:US
Practice Address - Phone:815-999-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional