MEDICARE: MR. WILLIAM DOUGLAS WAGNER MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	SW9961	FL
2	101YM0800X	Mental Health Counselor	356	KY

General Provider Information

NPI Number	:	1043594963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM DOUGLAS WAGNER MSW, LCSW

Provider Business Mailing Address
First Line	:	2139 PALM CT
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-5724
Country	:	US
Telephone Number	:	859-979-0160
Fax Number	:

Provider Business Practice Location Address
First Line	:	2139 PALM CT
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-5724
Country	:	US
Telephone Number	:	859-979-0160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	10/11/2011

Similar Medicare Providers

1194376228 — MELISSA L. RAMSDEN
Practice Location Address:

1211 WHISPERING SANDS ST
PORT ARANSAS, TX
78373-5724

Practice Phone: 361-779-2404
Practice Fax:

1538981436 — MIKAILY BUTCHKO MOT
Practice Location Address:

9637 RIVERCHASE DR
NEW PORT RICHEY, FL
34655-5724

Practice Phone: 727-207-8185
Practice Fax:

1578554853 — MMO JENNINGS, LLC
Practice Location Address:

728 NORTH BOULEVARD
BATON ROUGE, LA
70802-5724

Practice Phone: 225-293-6774
Practice Fax: 225-291-9229

1457640518 — CAROLINE BEALS N.P.
Practice Location Address:

300 LONGWOOD AVE , 7 NORTH
BOSTON, MA
02115-5724

Practice Phone: 617-355-8076
Practice Fax: 617-730-0902

1801174529 — MRS. KRISTAN MARIE BOUTWELL RN, CPNP
Practice Location Address:

300 LONGWOOD AVE , MAIN BUILDING, 7 NORTH NICU
BOSTON, MA
02115-5724

Practice Phone: 617-355-8076
Practice Fax: 617-730-0902

1710245030 — MITCHELL C. REID LCP
Practice Location Address:

3036 WADDINGTON DR
NORTH CHESTERFIELD, VA
23224-5724

Practice Phone: 804-343-7646
Practice Fax: 804-819-5221

Directions to “ MR. WILLIAM DOUGLAS WAGNER MSW, LCSW” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.