GERALD WAGNER

NEW LONDON, CT
NPI1962759084
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CT  000326)
Enumeration Date2012-08-08
Last Update Date2016-12-21
Business Address
Mr. GERALD WAGNER LADC
21 MONTAUK AVE
NEW LONDON, CT 06320-4906
Phone number: 860-271-4715
Mailing Address
Mr. GERALD WAGNER LADC
PO BOX 390
NEW LONDON, CT 06320-0390
Phone number: 860-271-4715
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