Provider Demographics
NPI:1811501224
Name:VITAMENTAL
Entity type:Organization
Organization Name:VITAMENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:GIACINTA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALARICO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-979-9780
Mailing Address - Street 1:274 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4091
Mailing Address - Country:US
Mailing Address - Phone:856-979-9780
Mailing Address - Fax:
Practice Address - Street 1:274 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4091
Practice Address - Country:US
Practice Address - Phone:856-979-9780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty