Provider Demographics
NPI:1811055205
Name:VIRRUSO, ELISSA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:M
Last Name:VIRRUSO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 FOX GLEN CT
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1833
Mailing Address - Country:US
Mailing Address - Phone:847-381-9870
Mailing Address - Fax:847-381-5059
Practice Address - Street 1:550 FOX GLEN CT
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1833
Practice Address - Country:US
Practice Address - Phone:847-381-9870
Practice Address - Fax:847-381-5059
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005949103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04925370OtherBLUE CROSS BLUE SHIELD