Individual
MS. CAROL THERESA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2780 SCHURZ AVE, BRONX, NY 10465-3234
(718) 863-9134
(718) 863-6125
Mailing address
286 LOGAN AVE, BRONX, NY 10465-3334
(718) 892-7599
(718) 892-3970
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
101YS0200X
School Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
PR029268-1
NY
1041S0200X
School Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147324
VALUE OPTIONS
—
Enumeration date
01/24/2007
Last updated
08/06/2010
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