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General NPI Number Information
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NPI Number | 1629586870
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH VITALE PHD
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Gender | Male
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 22 EAST ST STE 2
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City | PITTSTON
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State | PA
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Zip | 18640-1100
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Country | US
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Telephone | 570-335-0357
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Fax | 570-569-2453
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Provider Business Mailing Address
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Address Line | 233 DELAWARE AVE
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City | WEST PITTSTON
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State | PA
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Zip | 18643-2101
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Country | US
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Telephone | 570-498-6340
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS005212L
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License Number State | PA
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