Healthcare Provider Details

I. General information

NPI: 1265047799
Provider Name (Legal Business Name): VITA HEALTH SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 NEW PARK AVE STE 102
WEST HARTFORD CT
06110-1142
US

IV. Provider business mailing address

430 NEW PARK AVE STE 102
WEST HARTFORD CT
06110-1142
US

V. Phone/Fax

Practice location:
  • Phone: 844-830-7233
  • Fax:
Mailing address:
  • Phone: 844-830-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: NEIL LEIBOWITZ
Title or Position: MD
Credential:
Phone: 281-697-6942