MEDICARE: STEFANIE VITALE LCSW, C-SSWS

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	1041C0700X	Clinical Social Worker	44SC05938400	NJ
2	1041S0200X	School Social Worker	1200702	NC
3	1041S0200X	School Social Worker		NY
4	1041C0700X	Clinical Social Worker	0841661	NY
5	1041C0700X	Clinical Social Worker	C010347	NC

General Provider Information

NPI Number	:	1629525746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE VITALE LCSW, C-SSWS

Provider Business Mailing Address
First Line	:	111 GEMITH CT
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-3690
Country	:	US
Telephone Number	:	919-325-2265
Fax Number	:

Provider Business Practice Location Address
First Line	:	10520 LIGON MILL RD STE 100
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4575
Country	:	US
Telephone Number	:	919-769-3778
Fax Number	:

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

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	05/18/2026

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