MEDICARE: JO-ANN WAGNER 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	1041C0700X	Clinical Social Worker	0904000859	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000249	OTHER	VA	VALUE OPTIONS
2	13467	OTHER	VA	CIGNA
3	086720	OTHER	VA	OPTIMA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	380403	OTHER	VA	ANTHEM
6	323507	OTHER	VA	MHN
7	339165	OTHER	VA	MAMSI/ALLIANCE

General Provider Information

NPI Number	:	1417054172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO-ANN WAGNER LCSW

Provider Business Mailing Address
First Line	:	1318 JAMESTOWN RD
Second Line	:	SUITE 101
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3382
Country	:	US
Telephone Number	:	757-229-7927
Fax Number	:	757-253-8891

Provider Business Practice Location Address
First Line	:	1318 JAMESTOWN RD
Second Line	:	SUITE 101
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3382
Country	:	US
Telephone Number	:	757-229-7927
Fax Number	:	757-253-8891

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

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	07/09/2007

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Directions to “ JO-ANN WAGNER LCSW” Practice Location

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