Provider Demographics
NPI:1518475300
Name:KAPSINOW, MATTHEW (LADC, LPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KAPSINOW
Suffix:
Gender:M
Credentials:LADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DUNHAM DR
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1875
Mailing Address - Country:US
Mailing Address - Phone:203-214-9215
Mailing Address - Fax:
Practice Address - Street 1:960 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1645
Practice Address - Country:US
Practice Address - Phone:860-378-8090
Practice Address - Fax:860-378-8091
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001229101YA0400X
CT003335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)