Individual
DR. LUCAS BOSCO WANGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
715 EDGERTON STREET, MERRICK COMMUNITY SERVICES, ST. PAUL, MN 55130
(612) 360-1966
Mailing address
1311 4TH STREET SOUTH EAST SUITE 13531, WANGA & ASSOCIATES, MINNEAPOLIS, MN 55414
(612) 360-1966
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
362637
MN
103TC2200X
Clinical Child & Adolescent Psychologist
362637
MN
103TM1800X
Intellectual & Developmental Disabilities Psychologist
362637
MN
103TS0200X
School Psychologist
362637
MN
Other
Enumeration date
01/02/2014
Last updated
01/02/2014
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