Provider Demographics
NPI:1427442227
Name:VITALE, ALEXANDRA NICOLE (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:VITALE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:MISS
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:VITALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1129 NORTHERN BLVD STE 404
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3022
Mailing Address - Country:US
Mailing Address - Phone:929-404-3002
Mailing Address - Fax:
Practice Address - Street 1:1129 NORTHERN BLVD STE 404
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3022
Practice Address - Country:US
Practice Address - Phone:917-892-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health