Laura J Wagner, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW 8239 Issued in FL

Practice address

1100 Cesery Blvd Ste 11
Jacksonville, FL 32211-5656

Phone

(904) 745-3070

NPI assigned

Jan 11, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033269329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8572 ETHANS GLEN TER",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569069",
            "telephone_number": "904-226-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 CESERY BLVD STE 11",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322115656",
            "telephone_number": "904-745-3070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "LAURA",
        "middle_name": "J",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW 8239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Lynn Wagner, CNM, ARNP
• Elaine C. Wagner, D.D.S.
• Ellen Rogers Wagner, OD
• Kendra Anne Wagner, LMHC
• Kyle Wagner, DPT
• Marie Pierrette Wagner
• Robert Fredrick Wagner Jr., D.D.S.
• Shakita Maria Wagner
• Larry D Wagoner, PH.D., LMFT
• Aisha Waheed, M.D.

• Clinical Social Worker in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.