Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 014475 | NY |
N | 103TA0700X | Adult Development & Aging Psychologist | 014475 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 014475 | NY |
Y | 103G00000X | Clinical Psychologist | 014475 | NY |
Y | 103TC0700X | Clinical Psychologist | 014475 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 014475 | NY |
N | 103TF0000X | Family Psychologist | 014475 | NY |
N | 103TH0004X | Health Psychologist | 014475 | NY |
N | 103TP2701X | Group Psychotherapist | 014475 | NY |
NPI | 1437343985 |
---|---|
Provider Name | Dr. Elizabeth E Wagner |
First Address | White Plains, NY 10601-3528 |
Second Address | White Plains, NY 10601-3528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 28/08/2007 |