Provider Demographics
NPI:1558471599
Name:LUIZ, VIRGINIA A (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:A
Last Name:LUIZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-1001
Mailing Address - Country:US
Mailing Address - Phone:508-525-5757
Mailing Address - Fax:
Practice Address - Street 1:355 UNION ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-1001
Practice Address - Country:US
Practice Address - Phone:508-525-5757
Practice Address - Fax:508-998-2176
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10300291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110121992AMedicaid