Healthcare Provider Details

I. General information

NPI: 1023007630
Provider Name (Legal Business Name): YVONNE K. CAPUTO MA, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E BROAD ST
SOUDERTON PA
18964-1212
US

IV. Provider business mailing address

4355 CAMPBELL RD
PENNSBURG PA
18073-2602
US

V. Phone/Fax

Practice location:
  • Phone: 215-527-0638
  • Fax:
Mailing address:
  • Phone: 215-527-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS006958L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: