Provider Demographics
NPI:1619191913
Name:VITALETTI, ROBERT L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:VITALETTI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 LAWRENCE ST APT 4E
Mailing Address - Street 2:4E
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2062
Mailing Address - Country:US
Mailing Address - Phone:303-571-4200
Mailing Address - Fax:
Practice Address - Street 1:1616 17TH ST
Practice Address - Street 2:SUITE 567
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1271
Practice Address - Country:US
Practice Address - Phone:303-628-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1011103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist