Basic Information
| Provider Information | |||||||||
| NPI: | 1538537832 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAPOCCIA | ||||||||
| FirstName: | ERIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12110 CLAYTON RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149898150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12110 CLAYTON RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149898150 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2015 | ||||||||
| LastUpdateDate: | 09/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | 2011014763 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.