Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 010893 | NY |
Y | 103TC0700X | Clinical Psychologist | 010893 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | NC3973 | NC |
NPI | 1023023553 |
---|---|
Provider Name | Dr. Aureen P. Wagner |
First Address | Cary, NC 27518-8507 |
Second Address | Cary, NC 27518-8507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 25/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102026FC | (02) | NY |
5927745 | (02) | NY |
P010010893 | (02) | NY |
P030010893 | (02) | NY |
P040010893 | (02) | NY |