Healthcare Provider Details

I. General information

NPI: 1669425914
Provider Name (Legal Business Name): CHRISTIAN NICHOLAS CAPUTO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 ROANOKE AVE
RIVERHEAD NY
11901-2727
US

IV. Provider business mailing address

166 HAMPTON VISTA DR
MANORVILLE NY
11949-2861
US

V. Phone/Fax

Practice location:
  • Phone: 631-369-1718
  • Fax: 631-874-8618
Mailing address:
  • Phone: 631-369-1718
  • Fax: 631-874-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberRP003027-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: