| Doctor Name: | DR. NANCY JO EVANGELISTA |
| NPI Number: | 1699808519 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 009840-1 |
| Business Practice Address: | 10 Church St Alfred, NY - 148021102 |
| Business Phone Number: | 6079680616 |
| Business Fax Number: | 6075879533 |
| Mailing Address: | 10 Church St, ALFRED |
| State: | NY |
| Postal Code: | 148021102 |
| Phone Number: | 6079680616 |
| Fax Number: | 6075879533 |
| NPI Enumeration Date: | 03/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | 009840-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |