Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1063606424 |
---|---|
Provider Name | Dr. Carl William Cappello |
First Address | Bay Shore, NY 11706-7900 |
Second Address | Bay Shore, NY 11706-7900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2007 |
Last Update Date | 29/08/2007 |