Provider Demographics
NPI:1982056982
Name:VITI, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VITI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NW 23RD AVE BLDG 1-10
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3574
Mailing Address - Country:US
Mailing Address - Phone:352-271-8605
Mailing Address - Fax:
Practice Address - Street 1:825 NW 23RD AVE BLDG 1-10
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3574
Practice Address - Country:US
Practice Address - Phone:352-271-8605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW171521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical