Provider Demographics
NPI:1962647974
Name:VIETRO, ROBERT (MS LADC NCAC II)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:VIETRO
Suffix:
Gender:M
Credentials:MS LADC NCAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 POST RD W
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4208
Mailing Address - Country:US
Mailing Address - Phone:203-227-7644
Mailing Address - Fax:203-227-0037
Practice Address - Street 1:90 POST RD W
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4208
Practice Address - Country:US
Practice Address - Phone:203-227-7644
Practice Address - Fax:203-227-0037
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000324101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)