Provider Demographics
NPI:1639799232
Name:VITALE, DEBRA BETH (LISW, LMSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:BETH
Last Name:VITALE
Suffix:
Gender:F
Credentials:LISW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 LANDING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-7367
Mailing Address - Country:US
Mailing Address - Phone:216-408-8576
Mailing Address - Fax:
Practice Address - Street 1:949 LANDING OAKS DR
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-7367
Practice Address - Country:US
Practice Address - Phone:216-408-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000010292104100000X
OHI.0008000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker