Basic Information
| Provider Information | |||||||||
| NPI: | 1821323064 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VITA | ||||||||
| FirstName: | ABBIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 PROSPECT ST | ||||||||
| Address2: | |||||||||
| City: | ENFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060823443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602535035 | ||||||||
| FaxNumber: | 8602535036 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ENFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060823372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602539024 | ||||||||
| FaxNumber: | 8602539593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2009 | ||||||||
| LastUpdateDate: | 12/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 9494 | CT | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | SW14903 | FL | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.