Organization
KENNETH T CAPPUCCIO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH THOMAS CAPPUCCIO (PRESIDENT)
(908) 447-2913
Entity
Organization
Contact information
Practice address
2195 HAYSTACK WAY, MYRTLE BEACH, SC 29579-3276
(908) 447-2913
Mailing address
2195 HAYSTACK WAY, MYRTLE BEACH, SC 29579-3276
(908) 447-2913
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC04533100
NJ
Other
Enumeration date
01/29/2008
Last updated
09/27/2022
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