Provider Demographics
NPI:1609415017
Name:VITOLO, STEPHANIE LESLIE (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LESLIE
Last Name:VITOLO
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 1:585 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1203
Mailing Address - Country:US
Mailing Address - Phone:561-310-6745
Mailing Address - Fax:
Practice Address - Street 1:163 PLAZA RD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3264
Practice Address - Country:US
Practice Address - Phone:724-465-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health