=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033922992
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. ANTHONY B CAPRARA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2025
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2335 BURTON ST SE STE 210
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49506-4669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-236-3600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1635 E 13 MILE RD APT 302
-----------------------------------------------------
City | MADISON HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48071-5024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-406-5677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------