Provider Demographics
NPI:1225420912
Name:VINCAVAGE, LITA CARMELLA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LITA
Middle Name:CARMELLA
Last Name:VINCAVAGE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FIORE CT
Mailing Address - Street 2:
Mailing Address - City:DURYEA
Mailing Address - State:PA
Mailing Address - Zip Code:18642
Mailing Address - Country:US
Mailing Address - Phone:804-912-0057
Mailing Address - Fax:
Practice Address - Street 1:2500 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-1515
Practice Address - Country:US
Practice Address - Phone:570-342-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007522235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist