Healthcare Provider Details

I. General information

NPI: 1548288509
Provider Name (Legal Business Name): VITO JOHN DONGIOVANNI PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STATE ROUTE 1014
TORRANCE PA
15779-1111
US

IV. Provider business mailing address

P.O.BOX 111 TORRANCE STATE HOSPITAL
TORRANCE PA
15779-1111
US

V. Phone/Fax

Practice location:
  • Phone: 724-675-2001
  • Fax: 724-675-2003
Mailing address:
  • Phone: 724-667-5200
  • Fax: 724-675-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS-003275L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: