Provider Demographics
NPI:1760514533
Name:CAPACCIO, MATTEO (ACSW, LCSW, R)
Entity Type:Individual
Prefix:MR
First Name:MATTEO
Middle Name:
Last Name:CAPACCIO
Suffix:
Gender:M
Credentials:ACSW, LCSW, R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 W 8TH ST
Mailing Address - Street 2:#2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1242
Mailing Address - Country:US
Mailing Address - Phone:347-439-4818
Mailing Address - Fax:
Practice Address - Street 1:1641 W 8TH ST
Practice Address - Street 2:#2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1242
Practice Address - Country:US
Practice Address - Phone:347-439-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0575241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical