Individual
MR. JEFFREY M WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
500 MARKET STREET 1-G, PORTSMOUTH, NH 03801
(603) 427-1428
(603) 431-5538
Mailing address
500 MARKET STREET 1-G, PORTSMOUTH, NH 03801
(603) 427-1428
(603) 431-5538
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
396
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80000875
—
NH
Enumeration date
02/06/2007
Last updated
07/08/2007
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