| Doctor Name: | DR. MARA SANADI WAGNER |
| NPI Number: | 1245455138 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | 4122 |
| Business Practice Address: | 23 Pokonoket Ave Sudbury, MA - 017762320 |
| Business Phone Number: | 9784436769 |
| Business Fax Number: | 9784409914 |
| Mailing Address: | 23 Pokonoket Ave, SUDBURY |
| State: | MA |
| Postal Code: | 017762320 |
| Phone Number: | 9784436769 |
| Fax Number: | 9784409914 |
| NPI Enumeration Date: | 04/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 4122 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |