Provider Demographics
NPI:1417427378
Name:GRISSELLE VIRGA, LCSW, P.C.
Entity Type:Organization
Organization Name:GRISSELLE VIRGA, LCSW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRISSELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRGA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:631-972-3900
Mailing Address - Street 1:1520 JULIETTE WAY APT 2308
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2464
Mailing Address - Country:US
Mailing Address - Phone:631-972-3900
Mailing Address - Fax:
Practice Address - Street 1:1520 JULIETTE WAY APT 2308
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2464
Practice Address - Country:US
Practice Address - Phone:631-972-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty