Provider Demographics
NPI:1548780257
Name:CAPPUCCIO, DESIREE
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:CAPPUCCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 TILDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1435
Mailing Address - Country:US
Mailing Address - Phone:609-892-2733
Mailing Address - Fax:267-627-5861
Practice Address - Street 1:3470 TILDEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1435
Practice Address - Country:US
Practice Address - Phone:609-892-2733
Practice Address - Fax:267-627-5861
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00693300235Z00000X
PASL013435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist