Provider Demographics
NPI:1992724900
Name:COMPITELLO, VICKI JOAN (PHD)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:JOAN
Last Name:COMPITELLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 S MAIN ST UNIT 7-309
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4868
Mailing Address - Country:US
Mailing Address - Phone:508-694-3684
Mailing Address - Fax:508-694-3694
Practice Address - Street 1:14 FALLON RD
Practice Address - Street 2:
Practice Address - City:EASTHAM
Practice Address - State:MA
Practice Address - Zip Code:02642-1600
Practice Address - Country:US
Practice Address - Phone:508-694-3684
Practice Address - Fax:508-694-3694
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH422103TC2200X, 103T00000X, 103TP2701X, 103TC1900X
MA4281103TC2200X, 103TP2701X, 103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80003476Medicaid
NH80003476Medicaid