Provider Demographics
NPI:1548288509
Name:DONGIOVANNI, VITO JOHN (PSYD)
Entity type:Individual
Prefix:DR
First Name:VITO
Middle Name:JOHN
Last Name:DONGIOVANNI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 111
Mailing Address - Street 2:TORRANCE STATE HOSPITAL
Mailing Address - City:TORRANCE
Mailing Address - State:PA
Mailing Address - Zip Code:15779-1111
Mailing Address - Country:US
Mailing Address - Phone:724-667-5200
Mailing Address - Fax:724-675-2003
Practice Address - Street 1:STATE ROUTE 1014
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:PA
Practice Address - Zip Code:15779-1111
Practice Address - Country:US
Practice Address - Phone:724-675-2001
Practice Address - Fax:724-675-2003
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003275L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADO/631980Medicaid