Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 1647 | PR |
N | 103TC0700X | Clinical Psychologist | 1647 | PR |
Y | 103G00000X | Clinical Psychologist | PY10124 | FL |
Y | 103TC0700X | Clinical Psychologist | PY10124 | FL |
NPI | 1013088681 |
---|---|
Provider Name | Dr. Carmen C Capella |
First Address | Orlando, FL 32807-3562 |
Second Address | Orlando, FL 32807-3562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 09/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S54964 | (02) |