Healthcare Provider Details

I. General information

NPI: 1609673706
Provider Name (Legal Business Name): ALEXANDRIA GAYLE NUCCIO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N MAIN ST BLDG 1
LEEDS MA
01053-9764
US

IV. Provider business mailing address

422 MILL ST
WORCESTER MA
01602-2443
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-4040
  • Fax:
Mailing address:
  • Phone: 860-729-8416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: