Provider Demographics
NPI:1932879582
Name:VITALIANO, LEE (LCSW, NCPRSS)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:VITALIANO
Suffix:
Gender:F
Credentials:LCSW, NCPRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10424 WHITE PINTO CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-5492
Mailing Address - Country:US
Mailing Address - Phone:954-732-7409
Mailing Address - Fax:
Practice Address - Street 1:10424 WHITE PINTO CT
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449-5492
Practice Address - Country:US
Practice Address - Phone:561-434-5186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL189511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical