Healthcare Provider Details

I. General information

NPI: 1619683810
Provider Name (Legal Business Name): VETALI THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 7TH ST STE 303
LAUREL MD
20707-3959
US

IV. Provider business mailing address

603 7TH ST STE 303
LAUREL MD
20707-3959
US

V. Phone/Fax

Practice location:
  • Phone: 240-554-0004
  • Fax:
Mailing address:
  • Phone: 240-554-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health 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

VIII. Authorized Official

Name: DR. LESLY LEMUS
Title or Position: MANAGING MEMBER
Credential: LCSW-C
Phone: 908-377-2725