Cacapon Center for Growth, PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

CACAPON CENTER FOR GROWTH, PLLC

Practice address

144 Grove Heights Road
Berkeley Spring, WV 25411-4816

Phone

(304) 500-8133

NPI assigned

Sep 2, 2020

Last updated

Sep 2, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ryan Matthew Moon, MSW, LICSW

Title

Owner/Manager

Phone

(304) 702-4426

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599004800000",
    "number": "1003420522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 VALLEY RD # 368",
            "city": "BERKELEY SPRINGS",
            "state": "WV",
            "postal_code": "254114816",
            "telephone_number": "304-702-4426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 GROVE HEIGHTS ROAD",
            "city": "BERKELEY SPRING",
            "state": "WV",
            "postal_code": "254114816",
            "telephone_number": "304-500-8133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CACAPON CENTER FOR GROWTH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-02",
        "last_updated": "2020-09-02",
        "certification_date": "2020-08-26",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "304-702-4426",
        "authorized_official_credential": "MSW, LICSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.