Individual
STEPHANIE MARIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PLMHP
Contact information
Practice address
444 S 44TH ST, OMAHA, NE 68131-3727
(402) 559-6408
(402) 559-5737
Mailing address
ONE PARK AVE, 7TH FLOOR, NEW YORK, NY 10016
(646) 754-5068
(646) 754-9538
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
019668
NY
Other
Enumeration date
07/23/2010
Last updated
12/30/2014
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