Diane Wagner

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810006006 Issued in VA

Practice address

11325 Random Hills Rd Ste 360
Fairfax, VA 22030-0972

Phone

(703) 646-1518

NPI assigned

Jul 9, 2018

Sex

Female

Sole proprietor

No

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

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wagner Psychotherapy LLC

  • Clinical Psychologist
  • Fairfax, VA
  • NPI 1962179804

  DC

  Medicare reassignment NPD Authorized official
• Clinical Psychology Services PC

  • Clinical Psychologist
  • Fairfax, VA
  • NPI 1194818054

  DC

  Medicare reassignment NPD

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

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1194211540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10911 ADARE DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220323105",
            "telephone_number": "703-646-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11325 RANDOM HILLS RD STE 360",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220300972",
            "telephone_number": "703-646-1518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "DIANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-09",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810006006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raymond C Wadlow, MD
• Barbara Jane Wagar, PSY.D.
• Johanne Mae Waggy, NP
• Wagner Psychotherapy LLC
• Cecyle Wagner, PT, DPT
• Robert Harrison Wagner, MD
• Samuel Charles Wagner V, LPC
• Leina Wahba, MD
• Mira Wahba, PT
• Nadia Gayle Wahid, PT, DPT, ATC

• Clinical Psychologist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.