Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PS005117L | PA |
N | 103TC0700X | Clinical Psychologist | PS005117L | PA |
N | 103G00000X | Clinical Psychologist | PS005117-L | PA |
N | 103TC0700X | Clinical Psychologist | PS005117-L | PA |
N | 103TR0400X | Rehabilitation Psychologist | PS005117-L | PA |
NPI | 1336136308 |
---|---|
Provider Name | Dr. Wayne Robert D'agaro |
First Address | Duncansville, PA 16635-7515 |
Second Address | Altoona, PA 16602-2004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 08/07/2007 |