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General NPI Number Information
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NPI Number | 1740369677
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Entity Type | Individual
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Provider Name | LILIET WAGNER PSY. D.
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 22777 LYONS AVE STE 218
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City | NEWHALL
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State | CA
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Zip | 91321-2853
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Country | US
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Telephone | 661-347-8286
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Fax | 855-978-2704
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Provider Business Mailing Address
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Address Line | 10740 N COUNTRY DR
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City | EDMOND
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State | OK
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Zip | 73034-7615
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Country | US
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Telephone | 661-347-8286
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Fax | 818-474-7148
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY19080
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License Number State | CA
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