Provider Demographics
NPI:1477900439
Name:CAPOMACCHIO, AMES RYAN (MA, LPC, R-DMT)
Entity Type:Individual
Prefix:
First Name:AMES
Middle Name:RYAN
Last Name:CAPOMACCHIO
Suffix:
Gender:X
Credentials:MA, LPC, R-DMT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:CAPOMACCHIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 S YORK RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-3969
Mailing Address - Country:US
Mailing Address - Phone:267-294-5373
Mailing Address - Fax:
Practice Address - Street 1:350 S YORK RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-3969
Practice Address - Country:US
Practice Address - Phone:267-294-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008164101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional