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Individual
DR. MATTHEW T. WAGNER
Active
Individual
DR. MATTHEW T. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CLIN. PSYCHOLOGIST
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY19277
CA
103TF0000X
Family Psychologist
PSY 19277
CA
103TF0200X
Forensic Psychologist
PSY 19277
CA
103TH0100X
Health Service Psychologist
PSY 19277
CA
103TP2701X
Group Psychotherapy Psychologist
PSY 19277
CA
Other
Enumeration date
08/20/2010
Last updated
08/20/2010
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