Provider Demographics
NPI:1245553734
Name:VITALI, AMANDA LEIGH (LPC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEIGH
Last Name:VITALI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-0362
Mailing Address - Country:US
Mailing Address - Phone:570-878-8561
Mailing Address - Fax:
Practice Address - Street 1:403 SPINNER RD
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-7634
Practice Address - Country:US
Practice Address - Phone:570-253-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional