Provider Demographics
NPI:1699157859
Name:VITA, MAUREEN ELLEN (ATR-BC, LPC)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ELLEN
Last Name:VITA
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2904
Mailing Address - Country:US
Mailing Address - Phone:484-686-1162
Mailing Address - Fax:
Practice Address - Street 1:18 CHESTNUT RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2904
Practice Address - Country:US
Practice Address - Phone:484-686-1162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006899101YP2500X
PA12-006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC006899OtherLPC
PA12-006OtherATR-BC