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NPI Code Detail

MEDICARE: TRACEY FATZINGER PH.D.

MEDICARE: TRACEY FATZINGER PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist0810003548VA

General Provider Information

NPI Number : 1083874051
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACEY FATZINGER PH.D.
Provider Business Mailing Address
First Line : 221 STONEBRIDGE PLAZA AVE
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23225-6972
Country : US
Telephone Number : 804-378-6141
Fax Number : 804-378-6183
Provider Business Practice Location Address
First Line : 221 STONEBRIDGE PLAZA AVE
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23225-6972
Country : US
Telephone Number : 804-378-6141
Fax Number : 804-378-6183
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2008
Last Update Date : 05/05/2025

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