Active NPI
Vanessa Wagner, PSY. D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1083069173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 021495
- Practice address
- 175 W 13TH St Apt 1B
New York, NY 10011-7803 - Phone
- (646) 435-1528
- NPI assigned
- Apr 26, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 021495 | NY | Primary |
Addresses
Primary practice location
175 W 13TH St Apt 1B
New York, NY 10011-7803
Mailing address
175 W 13TH St Apt 1B
New York, NY 10011-7803
Phone (646) 435-1528
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021495 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472688000000",
"number": "1083069173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 W 13TH ST APT 1B",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100117803",
"telephone_number": "646-435-1528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 W 13TH ST APT 1B",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100117803",
"telephone_number": "646-435-1528"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "VANESSA",
"name_prefix": "Dr.",
"credential": "PSY. D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-26",
"last_updated": "2016-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "021495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.