Individual
MR. BRIAN R. WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A. C.A.S.A.C.
Contact information
Practice address
73 S CENTRAL AVE, VALLEY STREAM, NY 11580-5402
(516) 872-9698
(516) 872-8758
Mailing address
73 S CENTRAL AVE, VALLEY STREAM, NY 11580-5402
(516) 872-9698
(516) 872-8758
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10434
NY
Other
Enumeration date
08/19/2006
Last updated
07/08/2007
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