Provider Demographics
NPI:1821179839
Name:CAPPUCCILLI, JEANETTE M (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:M
Last Name:CAPPUCCILLI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:M
Other - Last Name:DEGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:108 LANCELOT LN
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1938
Mailing Address - Country:US
Mailing Address - Phone:315-435-7762
Mailing Address - Fax:315-435-3279
Practice Address - Street 1:520 CEDAR ST
Practice Address - Street 2:OCDMH DAY TREATMENT PROGRAM FOR CHILDREN
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2302
Practice Address - Country:US
Practice Address - Phone:315-435-7762
Practice Address - Fax:315-435-7715
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02788011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical