Doctor Name: | MS. JOANN VITANZA |
NPI Number: | 1184659146 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | R044914-1 |
Business Practice Address: | 982 Montauk Hwy Suite 7 Bayport, NY - 117051626 |
Business Phone Number: | 6312448933 |
Business Fax Number: | 6312448933 |
Mailing Address: | 982 Montauk Hwy, Suite 7 BAYPORT |
State: | NY |
Postal Code: | 117051626 |
Phone Number: | 6312448933 |
Fax Number: | 6312448933 |
NPI Enumeration Date: | 07/11/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | R044914-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |