Individual
KRISTEN ANN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LCSW-R
Contact information
Practice address
183 NIGHTINGALE WAY, SHEPHERDSVILLE, KY 40165-6329
(518) 210-4735
Mailing address
183 NIGHTINGALE WAY, SHEPHERDSVILLE, KY 40165-6329
(518) 210-4735
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R058112-1
NY
Other
Enumeration date
06/06/2006
Last updated
07/24/2012
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