MEDICARE: SHONNY L CAPODILUPO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	073022	NY

General Provider Information

NPI Number	:	1699713180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONNY L CAPODILUPO LCSW

Provider Business Mailing Address
First Line	:	667 STONELEIGH AVE STE 202
Second Line	:
City	:	CARMEL
State	:	NY
Zip	:	10512-2455
Country	:	US
Telephone Number	:	845-279-5908
Fax Number	:

Provider Business Practice Location Address
First Line	:	667 STONELEIGH AVE STE 202
Second Line	:
City	:	CARMEL
State	:	NY
Zip	:	10512-2455
Country	:	US
Telephone Number	:	845-279-5908
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	04/30/2025

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