Provider Demographics
NPI:1063763043
Name:VIRTUE, SERENE ANN (LMSW)
Entity type:Individual
Prefix:
First Name:SERENE
Middle Name:ANN
Last Name:VIRTUE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-3001
Mailing Address - Country:US
Mailing Address - Phone:518-434-6135
Mailing Address - Fax:518-434-1485
Practice Address - Street 1:95 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-3001
Practice Address - Country:US
Practice Address - Phone:518-434-6135
Practice Address - Fax:518-434-1485
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087616-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)