Individual
MR. WILLIAM G WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
1330 LOMAS BLVD NW, ALBUQUERQUE, NM 87104-1234
(505) 604-1640
Mailing address
2531 CAMPBELL RD NW, ALBUQUERQUE, NM 87104-3103
(505) 604-1640
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-3886
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39100201
—
NM
Enumeration date
10/29/2006
Last updated
07/08/2007
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