Provider Demographics
NPI:1669087474
Name:VITALE, CORINA DOROTHY
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:DOROTHY
Last Name:VITALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 N HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-8276
Mailing Address - Country:US
Mailing Address - Phone:415-382-3363
Mailing Address - Fax:
Practice Address - Street 1:1385 N HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-8276
Practice Address - Country:US
Practice Address - Phone:415-382-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000OtherHOUSING