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Organization
VT GERIATRIC PSYCHOLOGICAL SERVICES P.C.
Active
Organization
VT GERIATRIC PSYCHOLOGICAL SERVICES P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICTORIA PEZZULLO TATE (PSYCHOLOGIST)
(718) 268-6600
Entity
Organization
Contact information
Practice address
11835 QUEENS BLVD, SUITE 1403, FOREST HILLS, NY 11375-7200
(718) 268-6065
(718) 268-6600
Mailing address
11835 QUEENS BLVD, SUITE 1403, FOREST HILLS, NY 11375-7200
(718) 268-6600
(718) 268-6065
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810003679
VA
Other
Enumeration date
12/24/2013
Last updated
12/24/2013
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