Healthcare Provider Details

I. General information

NPI: 1013011691
Provider Name (Legal Business Name): MARIE ELIZABETH CAPOBIANCO MA, LMHC, LCDP, CCJP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTERVILLE RD. AND THE KENT CENTER SUITE 301
WARWICK RI
02886
US

IV. Provider business mailing address

300 CENTERVILLE RD. AND THE KENT CENTER SUITE 301
WARWICK RI
02886
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-5656
  • Fax:
Mailing address:
  • Phone: 401-732-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC000263
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCDP00302
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: