Wagner, Audrey
Wagner, Audrey is an sole proprietor health care provider with primary practice located at 173 Mount Auburn St , Watertown MA 02472-4005. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Wagner, Audrey can be contacted via phone (617) 923-2468.Contact Information
Primary practice address
173 Mount Auburn St
Watertown MA 02472-4005
Phone: (617) 923-2468
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 4685 | Massachusetts |
Profile Details
| NPI number | 1922047679 |
|---|---|
| LBN Legal business name | Wagner, Audrey |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 6th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1922047679 | NPPES |
| Massachusetts | Other | W04524 | BCBS |
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