Provider Demographics
NPI:1629414156
Name:VITELLO, JASON BRIAN (MSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:BRIAN
Last Name:VITELLO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 S SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3523
Mailing Address - Country:US
Mailing Address - Phone:706-627-8598
Mailing Address - Fax:
Practice Address - Street 1:2040 S SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3523
Practice Address - Country:US
Practice Address - Phone:706-627-8598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker