Individual
DR. PATRICIA ELLEN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
530 OAK ST, SYRACUSE, NY 13203-1652
(315) 478-5890
Mailing address
530 OAK ST, SYRACUSE, NY 13203-1652
(315) 478-5890
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
012016-1
NY
103TA0700X
Adult Development & Aging Psychologist
012016-1
NY
103TB0200X
Cognitive & Behavioral Psychologist
012016-1
NY
103TC0700X
Clinical Psychologist
012016-1
NY
103TC2200X
Clinical Child & Adolescent Psychologist
012016-1
NY
Other
Enumeration date
02/08/2007
Last updated
09/11/2025
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