Provider Demographics
NPI:1629525746
Name:VITALE, STEFANIE (LCSW, C-SSWS)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:VITALE
Suffix:
Gender:F
Credentials:LCSW, C-SSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GEMITH CT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-3690
Mailing Address - Country:US
Mailing Address - Phone:919-325-2265
Mailing Address - Fax:
Practice Address - Street 1:1900 S MAIN ST STE 112
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5027
Practice Address - Country:US
Practice Address - Phone:919-325-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0103471041C0700X
NJ44SC059384001041C0700X
NY1041S0200X
NC12007021041S0200X
NY08416611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool