Provider Demographics
NPI:1720409873
Name:VITALE, CHARLENE DANA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:DANA
Last Name:VITALE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 JOCKEY CT
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1922
Mailing Address - Country:US
Mailing Address - Phone:845-283-4101
Mailing Address - Fax:732-483-4427
Practice Address - Street 1:20 GIBSON PL
Practice Address - Street 2:SUITE 206
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4838
Practice Address - Country:US
Practice Address - Phone:732-483-4425
Practice Address - Fax:732-483-4427
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05944500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker