Provider Demographics
NPI:1366170979
Name:VITALE, AMELIA ROSE (LSW)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:ROSE
Last Name:VITALE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SECOND AVE APT 26
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-6268
Mailing Address - Country:US
Mailing Address - Phone:732-865-0587
Mailing Address - Fax:
Practice Address - Street 1:600 ROUTE 35
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5018
Practice Address - Country:US
Practice Address - Phone:732-706-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06801800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker