Provider Demographics
NPI:1225273451
Name:IALLONARDO, VITO M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VITO
Middle Name:M
Last Name:IALLONARDO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-1947
Mailing Address - Country:US
Mailing Address - Phone:860-399-9239
Mailing Address - Fax:860-399-7529
Practice Address - Street 1:1163 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-1947
Practice Address - Country:US
Practice Address - Phone:860-399-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0063401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical