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General NPI Number Information
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NPI Number | 1508729757
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Entity Type | Individual
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Provider Name | VINCENT DIVITO
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Gender | Male
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 1307 S INTERNATIONAL PKWY STE 2051
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City | LAKE MARY
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State | FL
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Zip | 32746-1414
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Country | US
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Telephone | 407-284-1191
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Fax |
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Provider Business Mailing Address
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Address Line | 118 E VILLA CAPRI CIR APT G
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City | DELAND
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State | FL
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Zip | 32724-7866
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH28079
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License Number State | FL
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