Provider Demographics
NPI:1215958111
Name:VITON, MINERVA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MINERVA
Middle Name:
Last Name:VITON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 EXECUTIVE CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1835
Mailing Address - Country:US
Mailing Address - Phone:561-436-7158
Mailing Address - Fax:561-736-0354
Practice Address - Street 1:5700 LAKE WORTH RD
Practice Address - Street 2:SUITE 205
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4727
Practice Address - Country:US
Practice Address - Phone:561-436-7158
Practice Address - Fax:561-736-0354
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5549101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU8595ZMedicare PIN