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General NPI Number Information
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NPI Number | 1194185207
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Entity Type | Individual
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Provider Name | THOMAS WAGNER
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Gender | Male
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 1881 WORCESTER RD
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City | FRAMINGHAM
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State | MA
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Zip | 01701-5410
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Country | US
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Telephone | 508-628-6650
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Fax |
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Provider Business Mailing Address
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Address Line | 1881 WORCESTER RD
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City | FRAMINGHAM
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State | MA
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Zip | 01701-5410
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Country | US
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Telephone | 508-628-6650
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1027416
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License Number State | MA
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