Healthcare Provider Details

I. General information

NPI: 1720383318
Provider Name (Legal Business Name): PSYCHOTHERAPY PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 PROSPECT AVE FIRST FLOOR, BOX #5
HARTFORD CT
06105-4238
US

IV. Provider business mailing address

682 PROSPECT AVE FIRST FLOOR, BOX #5
HARTFORD CT
06105-4238
US

V. Phone/Fax

Practice location:
  • Phone: 860-523-9011
  • Fax: 860-523-9011
Mailing address:
  • Phone: 860-523-9011
  • Fax: 860-523-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number001898
License Number StateCT

VIII. Authorized Official

Name: DR. ELIZABETH L VITALE
Title or Position: OWNER
Credential: MSN, PSYD
Phone: 860-523-9011