Individual
BROOKE LEIGH WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6539 ANTHONY DR STE A, VICTOR, NY 14564-1441
(585) 398-8835
Mailing address
2012 RAINBOW LN, LIMA, NY 14485-9453
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
093973-01
NY
Other
Enumeration date
09/14/2022
Last updated
09/14/2022
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