Basic Information
| Provider Information | |||||||||
| NPI: | 1003937046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAPONE | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | LPCMH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 N JAMES ST | ||||||||
| Address2: | SUITE 104-106 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198043169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026330301 | ||||||||
| FaxNumber: | 3026330331 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 N JAMES ST | ||||||||
| Address2: | SUITE 104-106 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198043169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026330301 | ||||||||
| FaxNumber: | 3026330331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PC-0000282 | DE | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 1000038094 | 05 | DE | MEDICAID | 1000038360 | 05 | DE | MEDICAID |