Provider Demographics
NPI:1619380169
Name:VITA, LAURAMARIE (LPC)
Entity Type:Individual
Prefix:
First Name:LAURAMARIE
Middle Name:
Last Name:VITA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HART ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1701
Mailing Address - Country:US
Mailing Address - Phone:508-234-4181
Mailing Address - Fax:508-234-3944
Practice Address - Street 1:5 HART ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1701
Practice Address - Country:US
Practice Address - Phone:860-229-4850
Practice Address - Fax:860-827-3472
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3379101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional