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Individual

RENAE L VITALE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSW, LCSW

Contact information

Practice address
205 S PARK LN, ALTUS, OK 73521-5755
(580) 379-6850
(580) 379-6859
Mailing address
PO BOX 8190, ALTUS, OK 73522-8190
(580) 379-6850

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4704
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200531990A
OK
Enumeration date
03/04/2014
Last updated
12/04/2023
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