MEDICARE: LINDSY KAE YARGER-WAGNER PSYD

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	103T00000X	Psychologist	09-28-PSY	VI
2	103T00000X	Psychologist	PS016535	PA

General Provider Information

NPI Number	:	1124273412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSY KAE YARGER-WAGNER PSYD

Provider Business Mailing Address
First Line	:	5030 ANCHOR WAY STE 9
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4692
Country	:	US
Telephone Number	:	340-719-7007
Fax Number	:	340-719-6655

Provider Business Practice Location Address
First Line	:	5030 ANCHOR WAY STE 9
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4692
Country	:	US
Telephone Number	:	340-719-7007
Fax Number	:	340-719-6655

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

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	01/10/2020

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