Provider Demographics
NPI:1619506854
Name:VITALE, ANITA MARIE (PHD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:VITALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANITA
Other - Middle Name:MARIE
Other - Last Name:VITALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANITA ALEXANDER, MS
Mailing Address - Street 1:100 W GORE ST STE 405
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1049
Mailing Address - Country:US
Mailing Address - Phone:321-841-3820
Mailing Address - Fax:321-843-6836
Practice Address - Street 1:100 W GORE ST STE 405
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1049
Practice Address - Country:US
Practice Address - Phone:321-841-3820
Practice Address - Fax:321-843-6836
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006450103T00000X, 103TC0700X
FLPY12368103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist