MEDICARE: STEVEN CAPASSO MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC38727	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MFC38727	OTHER	CA	BBS#

General Provider Information

NPI Number	:	1104021989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN CAPASSO MFT

Provider Business Mailing Address
First Line	:	1400 EMELINE AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-1976
Country	:	US
Telephone Number	:	831-454-3869
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 EMELINE AVE
Second Line	:	3650 GRAHAM HILL ROAD
City	:	SANTA CRUZ
State	:	CA
Zip	:	95061
Country	:	US
Telephone Number	:	831-454-3869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	07/08/2007

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