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General NPI Number Information
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NPI Number | 1376175539
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Entity Type | Organization
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Legal Business Name | REGINA E. VITALE LCSW P.C.
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Dates
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Enumeration Date | 02/06/2020
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 205 OAKVIEW AVE
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City | FARMINGDALE
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State | NY
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Zip | 11735-3710
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Country | US
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Telephone | 917-655-3509
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Fax |
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Provider Business Mailing Address
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Address Line | 3864 HOLLIS LN
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City | SEAFORD
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State | NY
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Zip | 11783-2031
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Country | US
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Telephone | 917-655-3509
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REGINA E. VITALE-MERCADO
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Credential | LCSW-R
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Telephone | 917-655-3509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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