Doctor Name: | MS. AMANDA WAGNER |
NPI Number: | 1144683574 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 37PC00547200 |
Business Practice Address: | 900 Darlington Ave Mahwah, NJ - 074302526 |
Business Phone Number: | 2019210256 |
Business Fax Number: | |
Mailing Address: | Po Box 184, WALDWICK |
State: | NJ |
Postal Code: | 074630184 |
Phone Number: | 2019210256 |
Fax Number: | |
NPI Enumeration Date: | 04/02/2016 |
NPI Last Update Date: | 04/02/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 37PC00547200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |