Provider Demographics
NPI:1093837981
Name:VITALE, CONSTANCE M (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:M
Last Name:VITALE
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 COUNTY ROUTE 23
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-4406
Mailing Address - Country:US
Mailing Address - Phone:518-483-2312
Mailing Address - Fax:
Practice Address - Street 1:57 RENNIE ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1138
Practice Address - Country:US
Practice Address - Phone:518-483-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002267-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health