| NPI | 1366779027 |
|---|---|
| Former Name | LISA C WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC 1000582) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 68 018233) |
| 103TC0700X Psychologist, Clinical (Licence: MD 05493) | |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2026-02-02 |