Healthcare Provider Details

I. General information

NPI: 1518110048
Provider Name (Legal Business Name): NATHAN L. VITON L.I.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N 116A
FARGO ND
58102-2417
US

IV. Provider business mailing address

2101 ELM ST N 116A
FARGO ND
58102-2417
US

V. Phone/Fax

Practice location:
  • Phone: 701-200-2723
  • Fax:
Mailing address:
  • Phone: 701-200-2723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4256
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: