Individual
MR. KENNETH THOMAS CAPPUCCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
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
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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