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:
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Health care specialties

SpecialtyCodeLicense #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 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518050731 NPPES
Florida MEDICAID 757008200

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