Individual
DR. MARK S. WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2824 COTTMAN AVE, SUITE 8, PHILADELPHIA, PA 19149-1400
(215) 331-7707
(215) 331-7790
Mailing address
2824 COTTMAN AVE, SUITE 8, PHILADELPHIA, PA 19149-1400
(215) 331-7707
(215) 331-7790
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS 003973L
PA
Other
Enumeration date
07/26/2006
Last updated
07/08/2007
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