Provider Demographics
NPI:1740210848
Name:CAPOZZOLO, MARIA ROSA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ROSA
Last Name:CAPOZZOLO
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 1:349 W COMMERCIAL ST STE 2795
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-2402
Mailing Address - Country:US
Mailing Address - Phone:585-340-2000
Mailing Address - Fax:585-340-2006
Practice Address - Street 1:349 W COMMERCIAL ST STE 2795
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-2402
Practice Address - Country:US
Practice Address - Phone:585-340-2000
Practice Address - Fax:585-340-2006
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015818235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355344Medicaid
NY11551142OtherCAQH