| Kenneth T Cappuccio Llc | |
|
2195 Haystack Way Myrtle Beach SC 29579-3276 | |
| (908) 447-2913 | |
| Not Available |
| Full Name | Kenneth T Cappuccio Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2195 Haystack Way, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Kenneth Thomas Cappuccio (PRESIDENT) |
| Authorized Official Contact | 9084472913 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth T Cappuccio Llc 2195 Haystack Way Myrtle Beach SC 29579-3276 Ph: (908) 447-2913 | Kenneth T Cappuccio Llc 2195 Haystack Way Myrtle Beach SC 29579-3276 Ph: (908) 447-2913 |
| NPI Number | 1023295367 |
|---|---|
| Provider Enumeration Date | 01/29/2008 |
| Last Update Date | 09/27/2022 |
| Certification Date | 09/27/2022 |
| Medicare PECOS PAC ID | 3577693522 |
|---|---|
| Medicare Enrollment ID | O20220304000889 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023295367 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 44SC04533100 (New Jersey) | Primary |
| Provider Name | Kenneth T Cappuccio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073674776 PECOS PAC ID: 2264479559 Enrollment ID: I20220303001807 |
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