Healthcare Provider Details

I. General information

NPI: 1487928347
Provider Name (Legal Business Name): MICHELE M CAPONI NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE M ACKERMAN CAPONI D.D.S.

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 BLACKTHORNE LANE
WEBSTER NY
14580-1005
US

IV. Provider business mailing address

518 BLACKTHORNE LANE
WEBSTER NY
14580-1005
US

V. Phone/Fax

Practice location:
  • Phone: 512-569-2199
  • Fax:
Mailing address:
  • Phone: 512-569-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number66617
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005397
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: