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NPI Code Detail

MEDICARE: MRS. EMILY DIANA CAPITO LCSW

MEDICARE: MRS. EMILY DIANA CAPITO LCSW
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
11041C0700XClinical Social Worker5844351--3501UT

General Provider Information

NPI Number : 1699093203
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. EMILY DIANA CAPITO LCSW
Provider Business Mailing Address
First Line : 344 E 100 S
Second Line : STE 301
City : SALT LAKE CITY
State : UT
Zip : 84111-1700
Country : US
Telephone Number : 801-428-3475
Fax Number : 801-322-2831
Provider Business Practice Location Address
First Line : 344 E 100 S
Second Line : STE 301
City : SALT LAKE CITY
State : UT
Zip : 84111-1700
Country : US
Telephone Number : 801-428-3475
Fax Number : 801-322-2831
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2010
Last Update Date : 05/06/2010

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