# VITALMD GROUP HOLDING LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043984941
- **Authorized official:** MS. JESSICA CAPOTE (MANAGED CARE DIRECTOR)
- **Authorized official phone:** (305) 273-4641

## Contact information

- **Practice address:** 3225 AVIATION AVE FL 4, MIAMI, FL 33133-4741
- **Practice address phone:** (305) 273-4641
- **Practice address fax:** (305) 631-7680
- **Mailing address:** 3225 AVIATION AVE FL 4, MIAMI, FL 33133-4741
- **Mailing address phone:** (305) 273-4641
- **Mailing address fax:** (305) 631-7680

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 103TF0000X | Family Psychologist | — | NULL | — |
| 103TF0000X | Family Psychologist | — | — | — |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 08/04/2021
- **Last updated:** 08/04/2021