Provider Demographics
NPI:1568883478
Name:CAPORASO, JEANICE GAIL (MSW, LIMHP)
Entity Type:Individual
Prefix:
First Name:JEANICE
Middle Name:GAIL
Last Name:CAPORASO
Suffix:
Gender:F
Credentials:MSW, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 926
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-0926
Mailing Address - Country:US
Mailing Address - Phone:303-522-1337
Mailing Address - Fax:303-522-1337
Practice Address - Street 1:127 W 2ND ST STE 201
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2883
Practice Address - Country:US
Practice Address - Phone:308-430-3070
Practice Address - Fax:308-432-4003
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10956101YM0800X
NE2176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health