Healthcare Provider Details

I. General information

NPI: 1982515110
Provider Name (Legal Business Name): CHRISTINA MARIE CAPOBIANCO I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 RESERVOIR AVE # 203
CRANSTON RI
02910-5138
US

IV. Provider business mailing address

281 KNOLLWOOD AVE
CRANSTON RI
02910-5129
US

V. Phone/Fax

Practice location:
  • Phone: 401-215-0354
  • Fax:
Mailing address:
  • Phone: 401-286-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00558-A
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: