Individual
MR. KENNETH THOMAS CAPPUCCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
14749
SC
1041C0700X
Clinical Social Worker
44SC04533100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
274527
MHN
—
01
—
465949000
MAGELLAN ICE
—
01
—
477445
VALUE OPTIONS
—
01
—
5907728
AETNA
—
Enumeration date
12/13/2006
Last updated
09/27/2022
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