JOHNATHAN VITAL

WALDORF, MD
NPI1477810067
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy103G00000X Clinical Neuropsychologist
(Licence: MD  04759)
Additional Taxonomies103T00000X Psychologist
(Licence: MD  04759)
103G00000X Clinical Neuropsychologist
(Licence: DC  PSY1000614)
103T00000X Psychologist
(Licence: DC  PSY1000614)
Enumeration Date2012-04-19
Last Update Date2012-04-20
Business Address
Dr. JOHNATHAN VITAL Ph.D.
2413 ALTENBURG CT
WALDORF, MD 20603
Phone number: 301-653-8828
Mailing Address
Dr. JOHNATHAN VITAL Ph.D.
2413 ALTENBURG CT
WALDORF, MD 20603
Phone number: 301-653-8828