Healthcare Provider Details

I. General information

NPI: 1134038920
Provider Name (Legal Business Name): GINA VITELLO ROCKWELL BSW, MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 HIDDEN GLEN CIR
ST CHARLES IL
60174-4422
US

IV. Provider business mailing address

1142 HIDDEN GLEN CIR
ST CHARLES IL
60174-4422
US

V. Phone/Fax

Practice location:
  • Phone: 630-290-3203
  • Fax:
Mailing address:
  • Phone: 630-290-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149012176
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: