Nancy Jo Evangelista, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

009840-1 Issued in NY

Practice address

10 Church St
Alfred, NY 14802-1102

Phone

(607) 968-0616

Fax

(607) 587-9533

NPI assigned

Mar 13, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699808519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 CHURCH ST",
            "city": "ALFRED",
            "state": "NY",
            "postal_code": "148021102",
            "telephone_number": "607-968-0616",
            "fax_number": "607-587-9533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 CHURCH ST",
            "city": "ALFRED",
            "state": "NY",
            "postal_code": "148021102",
            "telephone_number": "607-968-0616",
            "fax_number": "607-587-9533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANGELISTA",
        "first_name": "NANCY",
        "middle_name": "JO",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": "009840-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAHQ UNIVERSAL CREDENTIAL",
            "identifier": "11514985",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cindy L Coleman, RN, MS, FNP-C
• Ian Michael Cramer, MS, ATC
• John Avelino Delcampo, D.D.S.
• Sydney Demick, FNP-C
• Rebecca C. Dennis, FNP
• Kathryn Evans, M.S., LAT, ATC, CES
• Family Medical Health of Alfred, PLLC
• Gerard M. Gingras, ATC
• Liam Patrick Glover, MBA, ATC
• Douglas Graham, ATC

• Clinical Child & Adolescent Psychologist in Alfred, NY
• Providers in Alfred, NY by specialty
• Clinical Child & Adolescent Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.