Individual
AMY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-C
Contact information
Practice address
44 E GORDON ST, BEL AIR, MD 21014-2916
(410) 838-9000
(410) 838-8953
Mailing address
4623 FALLS RD, BALTIMORE, MD 21209-4914
(410) 366-1980
(410) 366-8530
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
07276
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017189100
—
MD
01
—
KL86
BCBS
MD
Enumeration date
12/08/2006
Last updated
10/07/2014
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