Provider Demographics
NPI:1134736747
Name:JENNIFER VIRGO THERAPY, PLLC
Entity type:Organization
Organization Name:JENNIFER VIRGO THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRGO
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LCSW-C, LCSW
Authorized Official - Phone:703-395-3032
Mailing Address - Street 1:3902 14TH ST NW APT 621
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5444
Mailing Address - Country:US
Mailing Address - Phone:703-395-3032
Mailing Address - Fax:
Practice Address - Street 1:3902 14TH ST NW APT 621
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5444
Practice Address - Country:US
Practice Address - Phone:703-395-3032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)