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General NPI Number Information
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NPI Number | 1407281413
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Entity Type | Organization
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Legal Business Name | GULF COAST PSYCHOLOGY, INC
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 5237 SUMMERLIN COMMONS BLVD SUITE 116
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City | FORT MYERS
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State | FL
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Zip | 33907-2158
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Country | US
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Telephone | 239-274-7792
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Fax | 239-247-5344
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Provider Business Mailing Address
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Address Line | 5237 SUMMERLIN COMMONS BLVD SUITE 116
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City | FORT MYERS
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State | FL
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Zip | 33907-2158
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Country | US
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Telephone | 239-274-7792
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Fax | 239-247-5344
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Authorized Official
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Title or Position | OWNER
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Name | DR. PASQUALE A CAPOZZOLI
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Credential | PSY.D.
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Telephone | 239-274-7792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY8575
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License Number State | FL
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