Individual
LORI WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
109 DANBURY ROAD, LOWER LEVEL, SUITE D6, RIDGEFIELD, CT 06877
(203) 494-8468
(845) 582-0764
Mailing address
109 DANBURY ROAD, LOWER LEVEL, SUITE D6, RIDGEFIELD, CT 06877-0687
(203) 494-8468
(845) 582-0764
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
2706
CT
Other
Enumeration date
12/05/2011
Last updated
05/18/2017
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