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Individual
SARAH LANE WAGNER
Active
Individual
SARAH LANE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
091363-1
NY
1041C0700X
Clinical Social Worker
Primary
090020-01
NY
Other
Enumeration date
03/26/2014
Last updated
10/15/2021
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