Individual
KELLY MARIE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1932 BROOKSBORO DR, ERIE, PA 16510-3872
(814) 708-2010
Mailing address
1932 BROOKSBORO DR, ERIE, PA 16510-3872
(814) 490-0015
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C018909
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C018909
LICENSE
NC
Enumeration date
12/13/2021
Last updated
12/02/2025
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