MEDICARE: ANNE THERESE VIRGONA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6851121068	MI

General Provider Information

NPI Number	:	1629238753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE THERESE VIRGONA

Provider Business Mailing Address
First Line	:	27351 DEQUINDRE RD
Second Line	:
City	:	MADISON HTS
State	:	MI
Zip	:	48071-3487
Country	:	US
Telephone Number	:	248-967-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	27351 DEQUINDRE RD
Second Line	:
City	:	MADISON HTS
State	:	MI
Zip	:	48071-3487
Country	:	US
Telephone Number	:	248-967-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	12/02/2025

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Directions to “ ANNE THERESE VIRGONA ” Practice Location

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