Healthcare Provider Details

I. General information

NPI: 1972298149
Provider Name (Legal Business Name): MADELINE ALEXANDRA PALERMO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELINE LAGACEY

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 13TH ST
OKLAHOMA CITY OK
73104-5004
US

IV. Provider business mailing address

700 NE 13TH ST
OKLAHOMA CITY OK
73104-5004
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4700
  • Fax:
Mailing address:
  • Phone: 405-271-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35935
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1522
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1522
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: