Wagner, Mary Abigail
Wagner, Mary Abigail is an individual health care provider with primary practice located at 5569 Broadcast Ct , Lakewood Ranch FL 34240-8472. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Wagner, Mary Abigail can be contacted via phone (941) 254-4900.Contact Information
Primary practice address
5569 Broadcast Ct
Lakewood Ranch FL 34240-8472
Phone: (941) 254-4900
Fax: (941) 355-2210
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | MH12245 | Florida |
Profile Details
| NPI number | 1518050731 |
|---|---|
| LBN Legal business name | Wagner, Mary Abigail |
| Credentials | LMHC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 2nd, 2006 |
| Last updated | Jan 13th, 2020 - about 4 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 | 1518050731 | NPPES |
| Florida | MEDICAID | 757008200 |
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