MEDICARE: DR. JAN MARIE CAPACCIOLI LCSW, LAADC, BCD

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	1041C0700X	Clinical Social Worker	LCS 27145	CA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCI02970315	CA

General Provider Information

NPI Number	:	1992931265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAN MARIE CAPACCIOLI LCSW, LAADC, BCD

Provider Business Mailing Address
First Line	:	350 SILER LN
Second Line	:	P.O. BOX 7046
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-3133
Country	:	US
Telephone Number	:	805-623-2203
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 E MAIN ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-4819
Country	:	US
Telephone Number	:	805-354-6000
Fax Number	:

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

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	03/09/2017

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