Provider Demographics
NPI:1033512298
Name:VITALE, GIOVANNI II (LLP)
Entity type:Individual
Prefix:MR
First Name:GIOVANNI
Middle Name:
Last Name:VITALE
Suffix:II
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 BEECHMONT ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1513
Mailing Address - Country:US
Mailing Address - Phone:313-969-7500
Mailing Address - Fax:
Practice Address - Street 1:23061 NONA ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2623
Practice Address - Country:US
Practice Address - Phone:313-969-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361000868103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral