Provider Demographics
NPI:1124361738
Name:SERVISS, VIRGINIA (MS MHC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:SERVISS
Suffix:
Gender:F
Credentials:MS MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1640
Mailing Address - Country:US
Mailing Address - Phone:845-391-6731
Mailing Address - Fax:
Practice Address - Street 1:1297 UNION AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1640
Practice Address - Country:US
Practice Address - Phone:845-391-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP82965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP82965OtherNEW YORK STATE PERMIT MENTAL HEALTH COUNSELOR