Provider Demographics
NPI:1972791820
Name:VITA, FRANK JAMES (PHD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:JAMES
Last Name:VITA
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 1:1747 E BROAD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5621
Mailing Address - Country:US
Mailing Address - Phone:570-501-1600
Mailing Address - Fax:570-501-1600
Practice Address - Street 1:1747 E BROAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5621
Practice Address - Country:US
Practice Address - Phone:570-501-1600
Practice Address - Fax:570-501-1600
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00215200101YP2500X
PAPS006535L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015541660005Medicaid
PA0015541660003Medicaid
PAVI564323OtherBLUE CROSS/BLUE SHIED
PAVI564323OtherBLUE CROSS/BLUE SHIED