Provider Demographics
NPI:1821987066
Name:VITRO, KUMUDUMALI MANISHA
Entity type:Individual
Prefix:DR
First Name:KUMUDUMALI
Middle Name:MANISHA
Last Name:VITRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N MAIN ST UNIT 1241
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7585
Mailing Address - Country:US
Mailing Address - Phone:914-236-4048
Mailing Address - Fax:
Practice Address - Street 1:245 N MAIN ST UNIT 1241
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-7585
Practice Address - Country:US
Practice Address - Phone:914-236-4048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP134328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health