Provider Demographics
NPI:1184320681
Name:CAPPUCCI, JANICE MINOR (ACBC)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:MINOR
Last Name:CAPPUCCI
Suffix:
Gender:F
Credentials:ACBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 ANDRETTI DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9830
Mailing Address - Country:US
Mailing Address - Phone:317-696-8133
Mailing Address - Fax:
Practice Address - Street 1:4001 ANDRETTI DR
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-9830
Practice Address - Country:US
Practice Address - Phone:317-696-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral