Provider Demographics
NPI:1639440761
Name:CAPITANO, SUSAN PATRICIA (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:PATRICIA
Last Name:CAPITANO
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 PASEO REYES DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8462
Mailing Address - Country:US
Mailing Address - Phone:904-610-6276
Mailing Address - Fax:904-512-0474
Practice Address - Street 1:264 PASEO REYES DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8462
Practice Address - Country:US
Practice Address - Phone:904-610-0299
Practice Address - Fax:904-512-0474
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health