AUDREY WAGNER (NPI# 1922047679) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922047679 |
| Entity Type | Individual |
| Full Name | AUDREY WAGNER |
| Credential | PH.D. |
| Practice Address |
173 Mount Auburn St Watertown MA 02472-4005 |
| Practice Telephone | 6179232468 |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
4685 | MA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | BCBS | W04524 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992161491 | Audrey Wagner | Pharmacist | 727 W Burnside St, Portland, OR 97209-3514 | 2016-01-13 |
| 1841465002 | Audrey Karin Wagner | Emergency Medicine | 345 Saint Paul St, Mercy Medical Center, 9th Floor, Icu, Baltimore, MD 21202-2123 | 2008-04-28 |
| 1699876755 | Audrey Ruth Wagner | Physical Therapist | 2775 Schoenersville Rd, Bethlehem, PA 18017-7307 | 2006-09-25 |
| 1639127152 | Audrey Susan Wagner | Internal Medicine | 485 Arsenal St, Internal Medicine, Watertown, MA 02472-5091 | 2006-05-05 |
| Street Address |
173 MOUNT AUBURN ST |
| City | WATERTOWN |
| State | MA |
| Zip Code | 02472-4005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366413841 | Charles Woodrow Styron Jr. | Psychologist | 173 Mount Auburn St, Watertown, MA 02472-4005 | 2006-01-31 |
| 1245866318 | Morgan Sutherland | Massage Therapist | 173 Mount Auburn St, Watertown, MA 02472-4005 | 2020-03-20 |
| 1447629977 | Carrie Pekor | Social Worker | 173 Mount Auburn St, Watertown, MA 02472-4005 | 2015-09-15 |
| 1912125444 | Claire R. Levine | Social Worker | 173 Mount Auburn St, Watertown, MA 02472-4005 | 2007-04-22 |
| 1346363603 | Rachel Crystal | Psychologist | 173 Mount Auburn St, Watertown, MA 02472-4005 | 2007-04-09 |
| 1245380377 | Lisa H. Wolfe | Psychologist | 173 Mount Auburn St, Watertown, MA 02472-4005 | 2007-01-11 |
| 1487713285 | Susan G Falkoff | Social Worker | 173 Mount Auburn St, Watertown, MA 02472-4005 | 2006-12-07 |
| 1871663989 | Jill A Fieleke | Nurse Practitioner | 173 Mount Auburn St, Watertown, MA 02472-4005 | 2006-11-08 |
| 1013952753 | Janice Stubblefield-tave | Social Worker | 173 Mount Auburn St, Watertown, MA 02472-4005 | 2006-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548735327 | Gladys Nakungu Kasansula | Counselor | Square Medical Group, 124 Watertown Street, Suite 2d, Watertown, MA 02472 | 2018-10-09 |
| 1447741962 | Hannah Edward | Optometrist | 550 Arsenal Street, Watertown, MA 02472 | 2018-05-21 |
| 1982193504 | Ruth Audrey Silverstein | Social Worker | Perkins School for The Blind, 175 North Beacon Street, Watertown, MA 02472 | 2018-05-09 |
| 1376067355 | Mostafa Medhati | Acupuncturist | 265 Lexington St., Watertown, MA 02472 | 2017-08-01 |
| 1003346313 | Eric Trant | Specialist/Technologist | 50 Columbia Street, Watertown, MA 02472 | 2017-06-19 |
| 1477007730 | Neangkanika Chea | Nurse Practitioner | 2 Repton Place, Apt 2204, Watertown, MA 02472 | 2016-08-04 |
| 1396128120 | Michelle Soares Darocha | Dentist | 18 Hovey Street, Watertown, MA 02472 | 2015-06-29 |
| 1760875496 | Ece Evin Yildirim | Acupuncturist | 557 Mt. Auburn St, Watertown, MA 02472 | 2015-03-05 |
| 1396140927 | Fabrizia Torazzi | Behavioral Analyst | 51 Water Street, Suite 200, Watertown, MA 02472 | 2014-10-24 |
| 1265774392 | Emilia Ann Fulop | Social Worker | 127 North Beacon Street, Watertown, MA 02472 | 2013-03-27 |
| Find all providers in zip 02472 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285123893 | Jennifer Smith Phd LLC | Psychologist | 10 Oliver Rd Unit 3, Watertown, MA 02472-4136 | 2018-05-09 |
| 1669746228 | Meaghan Creedon | Psychologist | 40 Spring St Ste 215, Watertown, MA 02472-3474 | 2012-02-29 |
| 1699078295 | Sean Martin Markey | Psychologist | 124 Watertown St Ste 2d, Watertown, MA 02472 | 2010-12-21 |
| 1396052940 | Katherine Dellaporta | Psychologist | 124 Watertown St Ste 3d, Watertown, MA 02472 | 2010-09-02 |
| 1922331123 | Alexander Solodyna | Psychologist | 40 Spring Street, Suite 215, Watertown, MA 02472 | 2009-09-08 |
| 1477763316 | Soren R. Ekstrom | Psychologist | 29 Chester St, Watertown, MA 02472-4002 | 2007-05-22 |
| 1164574448 | Cheryl Morrier | Psychologist | 19472 Washington Street, Watertown, NY 13601-3694 | 2007-01-17 |
| 1952469389 | Jeanne Emery | Psychologist | 238 Arsenal St., Watertown, NY 13601 | 2006-12-05 |
| 1750455044 | William Michael Keane | Psychologist | 17 Spring St, Watertown, MA 02472-3411 | 2006-11-20 |
| 1619061108 | Michael D Figueroa | Psychologist | 9933 Aspen St., Watertown, NY 13601 | 2006-10-02 |
| Find all providers in WATERTOWN | ||||
Please comment or provide details below to improve the information on AUDREY WAGNER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.