Basic Information
| Provider Information | |||||||||
| NPI: | 1326382631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DI PALMA | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, APRN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | FREDONIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140631132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166726117 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 400 FOREST AVE BLDG 51 | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142131207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168162445 | ||||||||
| FaxNumber: | 7168162357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2012 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 631277-1 | NY | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 403058 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 146013200 | 05 | NY | MEDICAID |