| Elizabeth Vitale, Msn, Psyd | |
|
682 Prospect Ave First Floor, Box #5 Hartford CT 06105-4238 | |
| (860) 523-9011 | |
| (860) 523-9011 |
| Full Name | Elizabeth Vitale, Msn, Psyd |
|---|---|
| Speciality | Psychologist |
| Location | 682 Prospect Ave, Hartford, Connecticut |
| Authorized Official Name and Position | Elizabeth L Vitale (OWNER) |
| Authorized Official Contact | 8605239011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elizabeth Vitale, Msn, Psyd 682 Prospect Ave First Floor, Box #5 Hartford CT 06105-4238 Ph: (860) 523-9011 | Elizabeth Vitale, Msn, Psyd 682 Prospect Ave First Floor, Box #5 Hartford CT 06105-4238 Ph: (860) 523-9011 |
| NPI Number | 1720383318 |
|---|---|
| Provider Enumeration Date | 01/13/2011 |
| Last Update Date | 01/13/2011 |
| Medicare PECOS PAC ID | 4486831534 |
|---|---|
| Medicare Enrollment ID | O20110527000149 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720383318 | NPI | - | NPPES |
| 004172871 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 001898 (Connecticut) | Primary |
| Provider Name | Elizabeth L Vitale |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386661841 PECOS PAC ID: 7810948247 Enrollment ID: I20110617000420 |
| Provider Name | Stewart L Wolff |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790813848 PECOS PAC ID: 4183801236 Enrollment ID: I20120712000399 |
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