Healthcare Provider Details

I. General information

NPI: 1942223946
Provider Name (Legal Business Name): ELISE ANNE CACCAPPOLO PHD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W 168TH ST
NEW YORK NY
10032-3726
US

IV. Provider business mailing address

710 W 168TH ST
NEW YORK NY
10032-3726
US

V. Phone/Fax

Practice location:
  • Phone: 646-426-3876
  • Fax: 212-305-1145
Mailing address:
  • Phone: 646-761-5166
  • Fax: 212-305-1145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number014270
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: