VT Geriatric Psychological Services P.C.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810003679 Issued in VA

Legal business name

VT GERIATRIC PSYCHOLOGICAL SERVICES P.C.

Practice address

11835 Queens Blvd
Suite 1403
Forest Hills, NY 11375-7200

Phone

(718) 268-6065

Fax

(718) 268-6600

NPI assigned

Dec 24, 2013

Last updated

Dec 24, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Victoria Pezzullo Tate

Title

Psychologist

Phone

(718) 268-6600

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1387843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387843200000",
    "number": "1932520665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11835 QUEENS BLVD",
            "address_2": "SUITE 1403",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757200",
            "telephone_number": "718-268-6600",
            "fax_number": "718-268-6065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11835 QUEENS BLVD",
            "address_2": "SUITE 1403",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757200",
            "telephone_number": "718-268-6065",
            "fax_number": "718-268-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VT GERIATRIC PSYCHOLOGICAL SERVICES P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-24",
        "last_updated": "2013-12-24",
        "status": "A",
        "authorized_official_last_name": "TATE",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "PEZZULLO",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "718-268-6600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810003679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.