Healthcare Provider Details

I. General information

NPI: 1639226061
Provider Name (Legal Business Name): STEPHANIE A VITANZA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 N. SCOTTSDALE ROAD SUITE 100
SCOTTSDALE AZ
85250
US

IV. Provider business mailing address

6615 N. SCOTTSDALE ROAD SUITE 100
SCOTTSDALE AZ
85250
US

V. Phone/Fax

Practice location:
  • Phone: 602-391-4308
  • Fax: 480-219-4605
Mailing address:
  • Phone: 602-391-4308
  • Fax: 480-219-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3425
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3425
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: