Provider Demographics
NPI:1114003134
Name:VIRGILIO, ANNE M (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:VIRGILIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:M
Other - Last Name:MCGREAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:17 WOODHOLLOW RD.
Mailing Address - Street 2:P.O. BOX 584
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-0584
Mailing Address - Country:US
Mailing Address - Phone:631-581-3194
Mailing Address - Fax:631-286-5720
Practice Address - Street 1:10 STATION CT
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2453
Practice Address - Country:US
Practice Address - Phone:631-286-5710
Practice Address - Fax:631-286-5720
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049326-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY049326OtherHIP HEALTH PLAN
NY127125OtherVYTRA PROVIDER NUMBER
NY2065197OtherCIGNA PROVIDER NUMBER
NY6259678OtherUNITED BEHAVIORAL HEALTH
NY7481809OtherGHI PROVIDER NUMBER
NY158830OtherVALUEOPTIONS PROVIDER NUM
NYP2550205OtherOXFORD HEALTH PLAN
NY02237034Medicaid
NY7648536OtherAETNA PROVIDER NUMBER
NY127125OtherVYTRA PROVIDER NUMBER