MEDICARE: JESSE COLIN CAPECE, LICSW

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	101YM0800X	Mental Health Counselor	ISW02202	RI

General Provider Information

NPI Number	:	1265827463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSE COLIN CAPECE, LICSW

Provider Business Mailing Address
First Line	:	81 JENCKES HILL RD
Second Line	:
City	:	LINCOLN
State	:	RI
Zip	:	02865-4603
Country	:	US
Telephone Number	:	401-323-0336
Fax Number	:

Provider Business Practice Location Address
First Line	:	81 JENCKES HILL ROAD
Second Line	:
City	:	LINCOLN
State	:	RI
Zip	:	02865-4603
Country	:	US
Telephone Number	:	401-323-0336
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	MR. JESSE COLIN CAPECE
Credential	:	LICSW
Telephone Number	:	401-323-0336

Provider Enumeration Date	:	04/03/2015
Last Update Date	:	04/03/2015

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