MEDICARE: CHRISTINE CAPUTO MS, LCPC

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	101YP2500X	Professional Counselor	178.008527	IL
2	101YP2500X	Professional Counselor	180009396	IL

General Provider Information

NPI Number	:	1710313614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE CAPUTO MS, LCPC

Provider Business Mailing Address
First Line	:	2331 WHITE ROSE DR
Second Line	:
City	:	MONTGOMERY
State	:	IL
Zip	:	60538-5140
Country	:	US
Telephone Number	:	815-830-3902
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 W WASHINGTON ST
Second Line	:	SUITE 325
City	:	OSWEGO
State	:	IL
Zip	:	60543-8214
Country	:	US
Telephone Number	:	813-830-3902
Fax Number	:

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

Provider Enumeration Date	:	09/24/2013
Last Update Date	:	11/04/2016

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