Healthcare Provider Details

I. General information

NPI: 1427442227
Provider Name (Legal Business Name): ALEXANDRA NICOLE VITALE LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ALEXANDRA VITALE

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 06/12/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 NORTHERN BLVD STE 404
MANHASSET NY
11030-3022
US

IV. Provider business mailing address

1129 NORTHERN BLVD STE 404
MANHASSET NY
11030-3022
US

V. Phone/Fax

Practice location:
  • Phone: 917-892-0111
  • Fax:
Mailing address:
  • Phone: 929-404-3002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

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: