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Individual

ANTONINA VITALE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
L.C.S.W.

Contact information

Practice address
4732 LONGHILL RD, SUITE 3202, WILLIAMSBURG, VA 23188-1584
(757) 758-6635
(757) 282-2546
Mailing address
4951 FENTON MILL RD, WILLIAMSBURG, VA 23188-6923
(757) 758-6635
(757) 282-2546

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904007245
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1497717615
VA PREMIER MEDICAID HMO
VA
05
1497717615
VA
01
294721
VALUE OPTIONS
VA
Enumeration date
11/09/2009
Last updated
03/17/2018
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