Healthcare Provider Details

I. General information

NPI: 1427965367
Provider Name (Legal Business Name): AMY WAGMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 P ST NW STE 220
WASHINGTON DC
20036-6923
US

IV. Provider business mailing address

4414 5TH ST NW
WASHINGTON DC
20011-4723
US

V. Phone/Fax

Practice location:
  • Phone: 202-944-0094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC200012978
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: