Provider Demographics
NPI:1831567957
Name:MAUREEN VITA LLC
Entity type:Organization
Organization Name:MAUREEN VITA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:VITA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ATR-BC, LPC
Authorized Official - Phone:484-686-1162
Mailing Address - Street 1:5 GREAT VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1426
Mailing Address - Country:US
Mailing Address - Phone:484-686-1162
Mailing Address - Fax:
Practice Address - Street 1:5 GREAT VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1426
Practice Address - Country:US
Practice Address - Phone:484-686-1162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-05
Last Update Date:2015-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006899251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health