| Doctor Name: | MS. MARY CATHERINE WAGNER |
| NPI Number: | 1003129529 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CAGS, LMHC |
| License Number: | 369291 |
| Business Practice Address: | 27 Water St #107b Wakefield, MA - 018803032 |
| Business Phone Number: | 9788271247 |
| Business Fax Number: | |
| Mailing Address: | Po Box 796, ASHBURNHAM |
| State: | MA |
| Postal Code: | 014300796 |
| Phone Number: | 9788271247 |
| Fax Number: | |
| NPI Enumeration Date: | 07/26/2010 |
| NPI Last Update Date: | 07/26/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 369291 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |