Individual
NANCY VITELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
115 N COLLEGE AVE STE 113, BLOOMINGTON, IN 47404-3933
(812) 335-4148
Mailing address
115 N COLLEGE AVE STE 113, BLOOMINGTON, IN 47404-3933
(812) 335-4148
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39000158A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000191123
ANTHEM PIN
—
01
—
7166248
AETNA PIN
—
Enumeration date
12/11/2006
Last updated
07/08/2007
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