Provider Demographics
NPI:1427124825
Name:TATE, VICTORIA PEZZULLO (PSYD, LCP)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:PEZZULLO
Last Name:TATE
Suffix:
Gender:
Credentials:PSYD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MUIRFIELD GREEN LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4517
Mailing Address - Country:US
Mailing Address - Phone:804-519-7191
Mailing Address - Fax:804-744-2101
Practice Address - Street 1:420 THIRD ST NE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901
Practice Address - Country:US
Practice Address - Phone:804-519-7191
Practice Address - Fax:804-744-2101
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003679103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA269349OtherANTHEM