Provider Demographics
NPI:1457037731
Name:CARLA VITOLA LLC
Entity Type:Organization
Organization Name:CARLA VITOLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VITOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:732-640-8471
Mailing Address - Street 1:70 PARK ST STE 104
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2960
Mailing Address - Country:US
Mailing Address - Phone:862-234-5029
Mailing Address - Fax:
Practice Address - Street 1:70 PARK ST STE 104
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2960
Practice Address - Country:US
Practice Address - Phone:862-234-5029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)