Provider Demographics
NPI:1407526999
Name:PEZZUTO, GINA ELIZABETH
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:ELIZABETH
Last Name:PEZZUTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 PRINCESS ANNE ST STE 407
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5804
Mailing Address - Country:US
Mailing Address - Phone:540-479-3889
Mailing Address - Fax:540-479-3946
Practice Address - Street 1:312 PROGRESS ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3356
Practice Address - Country:US
Practice Address - Phone:540-479-3908
Practice Address - Fax:540-479-1605
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000391103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst