=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174819932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY CAPONE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2011
-----------------------------------------------------
Last Update Date | 01/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3345 WAIKOMO RD APT 1
-----------------------------------------------------
City | KOLOA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96756-9764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-652-1874
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3345 WAIKOMO RD APT 1
-----------------------------------------------------
City | KOLOA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96756-9764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-652-1874
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------