Basic Information
| Provider Information | |||||||||
| NPI: | 1598107765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIZZUTO | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 HERITAGE WAY NE | ||||||||
| Address2: | STE 302 | ||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201764544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037715100 | ||||||||
| FaxNumber: | 7037775100 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 HERITAGE WAY NE | ||||||||
| Address2: | STE 302 | ||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201764544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037715100 | ||||||||
| FaxNumber: | 7037710170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2013 | ||||||||
| LastUpdateDate: | 01/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 0904010859 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.