Provider Demographics
NPI:1770922890
Name:VITELLO, NINA MARIE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:MARIE
Last Name:VITELLO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 VERMONT ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-8143
Mailing Address - Country:US
Mailing Address - Phone:860-316-9060
Mailing Address - Fax:
Practice Address - Street 1:26 VERMONT ST APT 3
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-8143
Practice Address - Country:US
Practice Address - Phone:860-316-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1263091041C0700X
1263091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical