Provider Demographics
NPI:1396985511
Name:VITAGLIANO, JAMES ALAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALAN
Last Name:VITAGLIANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CANTON ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3524
Mailing Address - Country:US
Mailing Address - Phone:603-625-1670
Mailing Address - Fax:603-625-0335
Practice Address - Street 1:30 CANTON ST
Practice Address - Street 2:SUITE 13
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3524
Practice Address - Country:US
Practice Address - Phone:603-625-1670
Practice Address - Fax:603-625-0335
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30420025Medicaid