Individual
MATTHEW RYAN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6601 VALENTINE WAY, SANTA FE, NM 87507-7301
(505) 988-1951
Mailing address
6601 VALENTINE WAY, SANTA FE, NM 87507-7301
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SWB-2022-0777
NM
Other
Enumeration date
06/13/2022
Last updated
01/02/2025
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