Healthcare Provider Details

I. General information

NPI: 1508342304
Provider Name (Legal Business Name): MAC CAPWELL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2018
Last Update Date: 09/30/2023
Certification Date: 09/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 CENTRAL AVE
NEEDHAM MA
02492-1410
US

IV. Provider business mailing address

709 W DALTON AVE
SPOKANE WA
99205-4929
US

V. Phone/Fax

Practice location:
  • Phone: 781-449-4500
  • Fax:
Mailing address:
  • Phone: 509-714-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier221822
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMA BOARD OF REGISTRATION OF SOCIAL WORKERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: