Provider Demographics
NPI:1508274101
Name:VITALETTI, BREANNA (LSW)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:VITALETTI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-3230
Mailing Address - Country:US
Mailing Address - Phone:610-435-1541
Mailing Address - Fax:610-435-4367
Practice Address - Street 1:530 UNION BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-3230
Practice Address - Country:US
Practice Address - Phone:610-435-1541
Practice Address - Fax:610-435-4367
Is Sole Proprietor?:No
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health