Carolyn Wagner

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

CAROLYN WAGNER

Practice address

1159 Wilmette Ave Ste 225
Wilmette, IL 60091-2653

Phone

(847) 728-8148

NPI assigned

Jun 16, 2020

Organization subpart

No

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

Authorized official

Name

Carolyn WagnerNPI 1467986141

Title

Psychotherapist

Phone

(847) 728-8148

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carolyn Wagner, MA, LPC

  • Professional Counselor
  • Wilmette, IL
  • NPI 1467986141
  NPD Authorized official

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

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592265600000",
    "number": "1164047072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1159 WILMETTE AVE STE 225",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912653",
            "telephone_number": "847-728-8148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1159 WILMETTE AVE STE 225",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912653",
            "telephone_number": "847-728-8148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLYN WAGNER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-16",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "847-728-8148"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.carolyn-wagner.com",
            "affiliation": "N",
            "address_1": "1159 Wilmette Ave Ste 225",
            "city": "Wilmette",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600912653",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Barbara L Caines, MSW;PEL
• Brad Campbell, D.C.
• William James Campbell, MD
• Kathryn Caneda
• Kaitlin Capozzi
• Holly Casey, M.S., R.D, L.D.
• Joseph R Ceisel, DDS
• Center for Artful Intention
• Center for Psychodynamic Psychotherapy, Inc.
• Morgan Chafshino

• Mental Health Clinic/Center (Including Community Mental Health Center) in Wilmette, IL
• Providers in Wilmette, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; 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.