Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 4956 | MA |
N | 103TS0200X | School Psychologist | 369291 | MA |
NPI | 1003129529 |
---|---|
Provider Name | Ms. Mary Catherine Wagner |
First Address | Ashburnham, MA 01430-0796 |
Second Address | Wakefield, MA 01880-3032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 26/07/2010 |