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General NPI Number Information
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NPI Number | 1154811727
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Entity Type | Individual
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Provider Name | CARLA RENEE VITOLA MA, MFT
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Gender | Female
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 70 PARK ST STE 104
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2960
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Country | US
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Telephone | 973-233-1000
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Fax | 973-233-1004
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Provider Business Mailing Address
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Address Line | 70 PARK ST STE 104
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2960
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Country | US
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Telephone | 856-371-8202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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