Provider Demographics
NPI:1861893232
Name:CAPPARELLI, ROXANNE S (LCSW)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:S
Last Name:CAPPARELLI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 NE 15TH AVE # 294
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2356
Mailing Address - Country:US
Mailing Address - Phone:503-208-8258
Mailing Address - Fax:503-328-7780
Practice Address - Street 1:2926 NE FLANDERS ST # 3A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3259
Practice Address - Country:US
Practice Address - Phone:503-208-8258
Practice Address - Fax:503-328-7780
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL114961041C0700X
ORL105871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1285418517Medicaid