MEDICARE: ROBERT VIETRO MS LADC NCAC II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	000324	CT

General Provider Information

NPI Number	:	1962647974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT VIETRO MS LADC NCAC II

Provider Business Mailing Address
First Line	:	90 POST RD W
Second Line	:
City	:	WESTPORT
State	:	CT
Zip	:	06880-4208
Country	:	US
Telephone Number	:	203-227-7644
Fax Number	:	203-227-0037

Provider Business Practice Location Address
First Line	:	90 POST RD W
Second Line	:
City	:	WESTPORT
State	:	CT
Zip	:	06880-4208
Country	:	US
Telephone Number	:	203-227-7644
Fax Number	:	203-227-0037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	04/04/2018

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