Provider Demographics
NPI:1881014082
Name:FURTICK, CAPUCINE (LMSW)
Entity Type:Individual
Prefix:
First Name:CAPUCINE
Middle Name:
Last Name:FURTICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 GRAND CONCOURSE
Mailing Address - Street 2:#3A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-2719
Mailing Address - Country:US
Mailing Address - Phone:718-588-9308
Mailing Address - Fax:
Practice Address - Street 1:910 GRAND CONCOURSE
Practice Address - Street 2:#3A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2719
Practice Address - Country:US
Practice Address - Phone:718-588-9308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-26
Last Update Date:2014-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical