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1336271477
TERESA LEE WAGNER
ITHACA, NY
NPI
1336271477
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: NY R042129-1)
Enumeration Date
2007-03-12
Last Update Date
2007-07-08
Business Address
-- TERESA LEE WAGNER M.S.W.
215 N GENEVA ST
ITHACA, NY 14850-4135
Phone number: 607-227-1026
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Mailing Address
-- TERESA LEE WAGNER M.S.W.
205 W NORTHVIEW RD
ITHACA, NY 14850-6041
Phone number: 607-273-6767
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