MEDICARE: ABBEY CAPODANNO MA

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

General Provider Information

NPI Number	:	1396439857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBEY CAPODANNO MA

Provider Business Mailing Address
First Line	:	844 E BROADWAY APT 3
Second Line	:
City	:	SOUTH BOSTON
State	:	MA
Zip	:	02127-2394
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 HANCOCK ST FL 9
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02171-1745
Country	:	US
Telephone Number	:	617-410-9328
Fax Number	:

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

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	06/07/2023

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