Healthcare Provider Details

I. General information

NPI: 1154995462
Provider Name (Legal Business Name): SARAH ROSE VITALE-SANTANA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH ROSE VITALE PSYD

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE # MLC4002
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 586-747-7416
  • Fax:
Mailing address:
  • Phone: 513-636-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP.08319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: