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General NPI Number Information
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NPI Number | 1174850325
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Entity Type | Individual
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Provider Name | ANTONINA VITALE L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 4732 LONGHILL RD SUITE 3202
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-1584
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Country | US
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Telephone | 757-758-6635
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Fax | 757-282-2546
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Provider Business Mailing Address
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Address Line | 4951 FENTON MILL RD
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-6923
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Country | US
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Telephone | 757-758-6635
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Fax | 757-282-2546
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007245
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License Number State | VA
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