Provider Demographics
NPI:1922276377
Name:ELISSA M VIRRUSO, PC
Entity Type:Organization
Organization Name:ELISSA M VIRRUSO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRRUSO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-769-7200
Mailing Address - Street 1:800 S NORTHWEST HWY
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4652
Mailing Address - Country:US
Mailing Address - Phone:847-381-9870
Mailing Address - Fax:847-381-5059
Practice Address - Street 1:800 S NORTHWEST HWY
Practice Address - Street 2:SUITE 102A
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-4652
Practice Address - Country:US
Practice Address - Phone:847-381-9870
Practice Address - Fax:847-381-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005949103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
04925370OtherBCBS