Provider Demographics
NPI:1851300776
Name:CAPSON, STEPHEN ALAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALAN
Last Name:CAPSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 7TH AVE
Mailing Address - Street 2:APT. 6- O
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7326
Mailing Address - Country:US
Mailing Address - Phone:212-924-7994
Mailing Address - Fax:
Practice Address - Street 1:252 7TH AVE
Practice Address - Street 2:APT. 6- O
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7326
Practice Address - Country:US
Practice Address - Phone:212-924-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7221103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV72351Medicare ID - Type Unspecified