Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY 2096 | FL |
Y | 103TC0700X | Clinical Psychologist | PY 2096 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY 2096 | FL |
NPI | 1033486535 |
---|---|
Provider Name | Dr. Larry David Capp |
First Address | North Miami Beach, FL 33179-4707 |
Second Address | North Miami Beach, FL 33179-4707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2011 |
Last Update Date | 28/11/2011 |