Provider Demographics
NPI:1346959806
Name:VITALE, ANTONIA KITHE
Entity Type:Individual
Prefix:MS
First Name:ANTONIA
Middle Name:KITHE
Last Name:VITALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-3114
Mailing Address - Country:US
Mailing Address - Phone:510-426-2069
Mailing Address - Fax:
Practice Address - Street 1:3837 LINDEN LN
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-3114
Practice Address - Country:US
Practice Address - Phone:510-426-2069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician