Healthcare Provider Details

I. General information

NPI: 1306647136
Provider Name (Legal Business Name): VIRTUOSO COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 S RIDGEWOOD AVE STE 13&17
EDGEWATER FL
32141-4240
US

IV. Provider business mailing address

664 ALDENHAM LN
ORMOND BEACH FL
32174-1019
US

V. Phone/Fax

Practice location:
  • Phone: 917-509-4038
  • Fax:
Mailing address:
  • Phone: 917-509-4038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. CARMEN MICHELE VIRTUOSO
Title or Position: OWNER
Credential: LCSW
Phone: 917-509-4038