Healthcare Provider Details

I. General information

NPI: 1013088681
Provider Name (Legal Business Name): CARMEN C CAPELLA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W OAK ST
KISSIMMEE FL
34741-4924
US

IV. Provider business mailing address

2450 FONDREN RD STE 312
HOUSTON TX
77063-2323
US

V. Phone/Fax

Practice location:
  • Phone: 713-789-7560
  • Fax: 713-789-7351
Mailing address:
  • Phone: 713-789-7560
  • Fax: 713-789-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10124
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1647
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: