Healthcare Provider Details

I. General information

NPI: 1154781102
Provider Name (Legal Business Name): MICHAEL JAMES CAPOZZI MS, LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 PIERCE ST STE 111
KINGSTON PA
18704-5512
US

IV. Provider business mailing address

109 VARHLEY ST
DUNMORE PA
18512-3154
US

V. Phone/Fax

Practice location:
  • Phone: 570-762-2583
  • Fax: 570-300-2629
Mailing address:
  • Phone: 570-851-8343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008513
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: