Provider Demographics
NPI:1699010264
Name:CAPPA, MICAELA SARAH (IMFT)
Entity Type:Individual
Prefix:MS
First Name:MICAELA
Middle Name:SARAH
Last Name:CAPPA
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SPRING STREET
Mailing Address - Street 2:STE 203
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-697-0470
Mailing Address - Fax:619-697-0505
Practice Address - Street 1:4700 SPRING ST
Practice Address - Street 2:STE 203
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0263
Practice Address - Country:US
Practice Address - Phone:619-697-0470
Practice Address - Fax:619-697-0505
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF73148106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist