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General NPI Number Information
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NPI Number | 1205874153
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Entity Type | Individual
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Provider Name | JANET MARGARET WAGNER LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 423 E 23RD ST
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City | NEW YORK
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State | NY
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Zip | 10010-5011
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Country | US
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Telephone | 212-462-4451
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Fax |
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Provider Business Mailing Address
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Address Line | 272 1ST AVE 2B
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City | NEW YORK
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State | NY
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Zip | 10009-1801
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Country | US
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Telephone | 212-505-2470
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | RO25558-1
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License Number State | NY
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