Provider Demographics
NPI:1720383318
Name:PSYCHOTHERAPY PARTNERS, LLC
Entity Type:Organization
Organization Name:PSYCHOTHERAPY PARTNERS, LLC
Other - Org Name:ELIZABETH VITALE, MSN, PSYD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PSYD
Authorized Official - Phone:860-523-9011
Mailing Address - Street 1:682 PROSPECT AVE
Mailing Address - Street 2:FIRST FLOOR, BOX #5
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4238
Mailing Address - Country:US
Mailing Address - Phone:860-523-9011
Mailing Address - Fax:860-523-9011
Practice Address - Street 1:682 PROSPECT AVE
Practice Address - Street 2:FIRST FLOOR, BOX #5
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4238
Practice Address - Country:US
Practice Address - Phone:860-523-9011
Practice Address - Fax:860-523-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001898103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004172871Medicaid
CT680001022Medicare UPIN