Individual
DR. ANDREA M WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
456 OLD NEWPORT BLVD, NEWPORT BEACH, CA 92663-4211
(949) 447-8257
Mailing address
456 OLD NEWPORT BLVD, NEWPORT BEACH, CA 92663-4211
(949) 447-8257
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
32730
CA
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
CA
103TC0700X
Clinical Psychologist
32730
CA
103TC0700X
Clinical Psychologist
5083
CT
103TF0200X
Forensic Psychologist
Primary
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
32730
CA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
CA
103TR0400X
Rehabilitation Psychologist
32730
CA
103TR0400X
Rehabilitation Psychologist
5083
CT
Other
Enumeration date
07/28/2016
Last updated
05/09/2026
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