Individual
AMY A VITALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,BA,LADC,LPC
Contact information
Practice address
250 W MAIN ST STE 301, BRANFORD, CT 06405-4032
(203) 779-6784
Mailing address
250 W MAIN ST STE 301, BRANFORD, CT 06405-4032
(203) 779-6784
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
972
CT
101YM0800X
Mental Health Counselor
3129
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008049844
—
CT
01
—
12653171
CAQH
CT
Enumeration date
09/23/2013
Last updated
04/27/2022
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