Individual
MR. GERALD WAGNER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
21 MONTAUK AVE, NEW LONDON, CT 06320-4906
(860) 271-4715
(860) 271-4797
Mailing address
PO BOX 390, NEW LONDON, CT 06320-0390
(860) 271-4715
(860) 271-4797
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000326
CT
Other
Enumeration date
08/08/2012
Last updated
12/21/2016
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