Healthcare Provider Details

I. General information

NPI: 1437308277
Provider Name (Legal Business Name): DONETTE MARY ALEXIS CLINICALPSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 E BASELINE RD
PHOENIX AZ
85042-6551
US

IV. Provider business mailing address

2318 W LONG SHADOW TRL
PHOENIX AZ
85085-6085
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax: 602-243-1235
Mailing address:
  • Phone: 718-938-1615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number005045
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: