Healthcare Provider Details

I. General information

NPI: 1780505495
Provider Name (Legal Business Name): ALEXANDRA NICOLETTI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CHESTER PIKE
SHARON HILL PA
19079-1903
US

IV. Provider business mailing address

23 APPLE AVE
BELLMAWR NJ
08031-1217
US

V. Phone/Fax

Practice location:
  • Phone: 610-583-3800
  • Fax:
Mailing address:
  • Phone: 585-319-9596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number020853
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: