Nicole S. Wagner, PH.D., LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6025 Issued in OH

Legal business name

NICOLE S. WAGNER, PH.D., LLC

Practice address

11740 Clifton Blvd
Suite 202
Lakewood, OH 44107-2057

Phone

(216) 548-5469

NPI assigned

Feb 12, 2008

Last updated

Feb 12, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nicole S Wagner, PH.D.NPI 1295803476

Title

Managing Partner

Phone

(216) 548-5469

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole S Wagner, PH.D.

  • Clinical Psychologist
  • Beachwood, OH
  • NPI 1295803476
  Authorized official Same address or phone
• Anne Wayant, LISW

  • Clinical Social Worker
  • Willoughby, OH
  • NPI 1396863023
  NPD (past)

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

{
    "created_epoch": "1202774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202774400000",
    "number": "1053589135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11740 CLIFTON BLVD",
            "address_2": "SUITE 202",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441072057",
            "telephone_number": "216-548-5469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11740 CLIFTON BLVD",
            "address_2": "SUITE 202",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441072057",
            "telephone_number": "216-548-5469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLE S. WAGNER, PH.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-12",
        "last_updated": "2008-02-12",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "216-548-5469",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "6025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• New Avenues to Independence, Inc. (New Avenues-Clifton)
• New Avenues to Independence, Inc. (New Avenues-Lakewood)
• Next Level Pelvic Health Therapy
• Calvin NG
• Julie Nguyen
• Nitin Govani MD PC
• Tyler Joseph Nolan, MD
• Allison K Norris, D.C.
• North Coast Health
• North Point Medical Associates, Inc.

• Clinical Psychologist in Lakewood, OH
• Providers in Lakewood, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; 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.