Individual
DR. MARK H. WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
75 NEW SCOTLAND AVE, CDPC - CHILD AND ADOLESCENT SERVICE, ALBANY, NY 12208-3409
(518) 447-9647
(518) 426-2902
Mailing address
75 NEW SCOTLAND AVE, CDPC - CHILD AND ADOLESCENT SERVICE, ALBANY, NY 12208-3409
(518) 447-9647
(518) 426-2902
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
018860
NY
Other
Enumeration date
01/07/2011
Last updated
01/07/2011
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