Provider Demographics
NPI:1356742795
Name:VIRGO, LUCY GAIL (MSW)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:GAIL
Last Name:VIRGO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 NE 155TH TER
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-5623
Mailing Address - Country:US
Mailing Address - Phone:786-304-0745
Mailing Address - Fax:
Practice Address - Street 1:1411 NE 155TH TER
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-5623
Practice Address - Country:US
Practice Address - Phone:786-304-0745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical