Individual
DARRAH A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW,RN
Contact information
Practice address
29 FRANKLIN ST, BANGOR, ME 04401-4909
(207) 942-3816
(207) 561-4725
Mailing address
29 FRANKLIN ST, BANGOR, ME 04401-4909
(207) 942-3816
(207) 561-4725
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LC8702
ME
163WP0808X
Psychiatric/Mental Health Registered Nurse
R026710
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098304
ANTHEM LEGACY - LCSW
ME
05
—
431984999
—
ME
Enumeration date
06/09/2006
Last updated
05/04/2011
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