Individual
DR. MARK WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
23 POKONOKET AVE, SUDBURY, MA 01776-2320
(978) 443-6769
Mailing address
23 POKONOKET AVE, SUDBURY, MA 01776-2320
(978) 443-6769
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4472
MA
Other
Enumeration date
01/19/2007
Last updated
05/01/2008
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