Provider Demographics
NPI:1902785736
Name:VITALE, ROBERT STEVEN (CRPA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STEVEN
Last Name:VITALE
Suffix:
Gender:M
Credentials:CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 IBSEN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1915
Mailing Address - Country:US
Mailing Address - Phone:917-202-1389
Mailing Address - Fax:
Practice Address - Street 1:3 IBSEN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1915
Practice Address - Country:US
Practice Address - Phone:917-202-1389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5506101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)