Provider Demographics
NPI:1881479558
Name:CAPOBIANCO, KERI (RN, PMHNP)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:CAPOBIANCO
Suffix:
Gender:
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OSCARS WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2462
Mailing Address - Country:US
Mailing Address - Phone:617-504-0850
Mailing Address - Fax:
Practice Address - Street 1:199 ROSEWOOD DR STE 300
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1388
Practice Address - Country:US
Practice Address - Phone:978-824-4205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN205834163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health