MEDICARE: MS. ANDREA CAPOLUPO MS

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1457899718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA CAPOLUPO MS

Provider Business Mailing Address
First Line	:	55 KNOLLS CRESCENT
Second Line	:
City	:	RIVERDALE
State	:	NY
Zip	:	10463
Country	:	US
Telephone Number	:	917-846-9475
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 KNOLLS CRES
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-6331
Country	:	US
Telephone Number	:	917-846-9475
Fax Number	:

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

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	02/07/2017

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