Individual
MATTHEW ANTHONY CAPEZZUTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
22540 LORAIN RD, FAIRVIEW PARK, OH 44126-2212
(440) 734-4037
(440) 734-4710
Mailing address
22540 LORAIN RD, FAIRVIEW PARK, OH 44126-2212
(440) 734-4037
(440) 734-4710
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
7071
OH
1041C0700X
Clinical Social Worker
I7623
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2594518
MEDICAID PROVIDER REPORTING NUMBER
OH
Enumeration date
09/15/2006
Last updated
04/15/2017
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