Provider Demographics
NPI:1861605511
Name:VITALE, SENIA L (PHD)
Entity type:Individual
Prefix:DR
First Name:SENIA
Middle Name:L
Last Name:VITALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7177 BROCKTON AVENUE
Mailing Address - Street 2:SUITE 335
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2634
Mailing Address - Country:US
Mailing Address - Phone:951-369-7288
Mailing Address - Fax:951-369-1064
Practice Address - Street 1:7177 BROCKTON AVENUE
Practice Address - Street 2:SUITE 335
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2634
Practice Address - Country:US
Practice Address - Phone:951-369-7288
Practice Address - Fax:951-369-1064
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14809103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical