Provider Demographics
NPI:1023531068
Name:VITELLI-HAGAN, KAY ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:ELLEN
Last Name:VITELLI-HAGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PARROTT RD
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1025
Mailing Address - Country:US
Mailing Address - Phone:845-627-4700
Mailing Address - Fax:
Practice Address - Street 1:65 PARROTT RD
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1025
Practice Address - Country:US
Practice Address - Phone:845-627-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0806581041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool