Provider Demographics
NPI:1427289628
Name:VITOLO, ALAN ANTHONY (PHD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ANTHONY
Last Name:VITOLO
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 1:5435 COLLEGE AVE
Mailing Address - Street 2:SUITE 202-6
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1598
Mailing Address - Country:US
Mailing Address - Phone:510-547-7669
Mailing Address - Fax:510-643-5336
Practice Address - Street 1:5435 COLLEGE AVE
Practice Address - Street 2:SUITE 202-6
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1598
Practice Address - Country:US
Practice Address - Phone:510-547-7669
Practice Address - Fax:510-643-5336
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14647103T00000X, 103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily