Provider Demographics
NPI:1578123659
Name:CAPOTORTO, KIERSTEN ANNE-MOORE
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:ANNE-MOORE
Last Name:CAPOTORTO
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 1:162 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-4404
Mailing Address - Country:US
Mailing Address - Phone:860-613-9930
Mailing Address - Fax:860-613-9952
Practice Address - Street 1:73 ELM ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2340
Practice Address - Country:US
Practice Address - Phone:203-843-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty