Organization
ANXIETY TREATMENT CENTER, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD G. WAGNER LCSW (OWNER)
(215) 962-0701
Entity
Organization
Contact information
Practice address
15 PATRIOTS PATH, SOUTH BOUND BROOK, NJ 08880-1495
(215) 962-0701
(732) 356-1883
Mailing address
15 PATRIOTS PATH, SOUTH BOUND BROOK, NJ 08880-1495
(215) 962-0701
(732) 356-1883
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC05343200
NJ
Other
Enumeration date
04/14/2014
Last updated
04/14/2014
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