Healthcare Provider Details

I. General information

NPI: 1972995652
Provider Name (Legal Business Name): A NEW PATH COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALBANY TPKE
CANTON CT
06019-2516
US

IV. Provider business mailing address

102 E MOUNTAIN RD
CANTON CT
06019-2041
US

V. Phone/Fax

Practice location:
  • Phone: 860-480-7393
  • Fax:
Mailing address:
  • Phone: 860-480-7393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARJORIE VITALE
Title or Position: OWNER
Credential: PSY.D.
Phone: 860-480-7393