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4732 Longhill Rd Ste 3202 Williamsburg VA 23188-1586 | |
| (757) 758-6635 | |
| (757) 282-2546 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 4732 Longhill Rd Ste 3202, Williamsburg, Virginia |
| Authorized Official Name and Position | Antonina Vitale (OWNER) |
| Authorized Official Contact | 9176275313 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4951 Fenton Mill Rd Williamsburg VA 23188-6923 Ph: (917) 627-5313 | 4732 Longhill Rd Ste 3202 Williamsburg VA 23188-1586 Ph: (757) 758-6635 |
| NPI Number | 1558876268 |
|---|---|
| Provider Enumeration Date | 12/05/2017 |
| Last Update Date | 03/17/2018 |
| Medicare PECOS PAC ID | 4880958834 |
|---|---|
| Medicare Enrollment ID | O20180430000605 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558876268 | NPI | - | NPPES |
| 230356841 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0904007245 (Virginia) | Primary |
| Provider Name | Antonina Vitale |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174850325 PECOS PAC ID: 0345380291 Enrollment ID: I20091228000285 |
| Provider Name | Laura Griffin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841927217 PECOS PAC ID: 7618332636 Enrollment ID: I20230426003131 |
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