Individual
DR. JANIS ANN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
521 MOUNT AUBURN ST, SUITE 107-109, WATERTOWN, MA 02472-4191
(617) 416-7815
(781) 719-5039
Mailing address
17 GROVE ST, UNIT 3, BOSTON, MA 02114-3408
(617) 416-7815
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY2351PR
MA
Other
Enumeration date
01/23/2007
Last updated
06/17/2014
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