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DR. VICTORIA PEZZULLO TATE PSYD, LCP

Clinical Neuropsychologist

Charlottesville, Virginia

Provider NPI: 1427124825

Provider Information:
DR. VICTORIA PEZZULLO TATE PSYD, LCP
Gender: F
Sole Proprietor


Practice Location:
420 THIRD ST NE  CHARLOTTESVILLE, VA 22901 US
Tel: 804-519-7191  Fax: 804-744-2101

Business Mailing Address:
17 MUIRFIELD GREEN LN  MIDLOTHIAN, VA 23112 US
Tel: 804-519-7191  Fax: 804-744-2101

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
VA0810003679

Other Provider Identifiers:

IssuerNumberStateType
ANTHEM269349VA01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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