Provider Demographics
NPI:1053099408
Name:CAPOZZA, CARLYNN
Entity type:Individual
Prefix:
First Name:CARLYNN
Middle Name:
Last Name:CAPOZZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:CAPOZZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2386 FARADAY AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7222
Mailing Address - Country:US
Mailing Address - Phone:760-496-9394
Mailing Address - Fax:
Practice Address - Street 1:2386 FARADAY AVE STE 140
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7222
Practice Address - Country:US
Practice Address - Phone:760-496-9394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT139793106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist