Healthcare Provider Details

I. General information

NPI: 1164638086
Provider Name (Legal Business Name): KATHRYN DEMARINIS CAPOZZOLI APRN, BC, PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RIGGS AVE
SEVERNA PARK MD
21146
US

IV. Provider business mailing address

201 SEVERN RIVER RD
SEVERNA PARK MD
21146-4637
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-2792
  • Fax: 410-263-9593
Mailing address:
  • Phone: 410-647-8765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR055419
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: