Individual
MADELINE ANNE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D,
Contact information
Practice address
328 BROADWAY, CAMBRIDGE, MA 02139-1840
(617) 661-9989
(978) 371-0643
Mailing address
328 BROADWAY, CAMBRIDGE, MA 02139-1840
(617) 661-9989
(978) 371-0643
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5038
MA
Other
Enumeration date
01/08/2007
Last updated
07/08/2007
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