Provider Demographics
NPI:1134588965
Name:VIRELLA, LUIS (LCSW, LCADC)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:VIRELLA
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2738
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08362-2738
Mailing Address - Country:US
Mailing Address - Phone:609-346-8740
Mailing Address - Fax:
Practice Address - Street 1:2581 E CHESTNUT AVE STE B-3
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8487
Practice Address - Country:US
Practice Address - Phone:609-346-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2024-04-10
Deactivation Date:2018-02-22
Deactivation Code:
Reactivation Date:2018-03-27
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00241500101YA0400X
NJ44SC05660000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0010138Medicaid