Provider Demographics
NPI:1881675189
Name:CAPONE, LYNN R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:R
Last Name:CAPONE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 MACKENZIE DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1660
Mailing Address - Country:US
Mailing Address - Phone:419-222-5672
Mailing Address - Fax:419-222-6786
Practice Address - Street 1:1045 MACKENZIE DR
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1660
Practice Address - Country:US
Practice Address - Phone:419-222-5672
Practice Address - Fax:419-222-6786
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCACP23361Medicare ID - Type Unspecified