MEDICARE: DR. ROBERT L. VITALETTI PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1011	CO

General Provider Information

NPI Number	:	1619191913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L. VITALETTI PH.D.

Provider Business Mailing Address
First Line	:	1350 LAWRENCE ST APT 4E
Second Line	:	4E
City	:	DENVER
State	:	CO
Zip	:	80204-2062
Country	:	US
Telephone Number	:	303-571-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 17TH ST
Second Line	:	SUITE 567
City	:	DENVER
State	:	CO
Zip	:	80202-1271
Country	:	US
Telephone Number	:	303-628-5425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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