Molly Marie Wagner, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW015648 Issued in PA

Practice address

1001 State St Ste 102
Erie, PA 16501-1835

Phone

(814) 580-1743

Fax

(814) 240-6347

NPI assigned

May 4, 2007

Last updated

Dec 17, 2019By the provider in NPPES

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

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1225240922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 W ELM ST",
            "city": "TITUSVILLE",
            "state": "PA",
            "postal_code": "163541462",
            "telephone_number": "814-516-2744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 STATE ST STE 102",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165011835",
            "telephone_number": "814-580-1743",
            "fax_number": "814-240-6347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MOLLY",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW015648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wagner Behavioral Health Services, LLC
• Julia Alexandra Wagner, PA-C
• Kayleigh Wagner, LAT, ATC
• Kelly Marie Wagner, LCSW
• Linda Wagner
• Richard John Wagner Jr., DO
• Marlene Wahlster
• Allison J Wahoff, D.O.
• Michael Steven Wahoff, PT
• Leslie Ann Waid, CRNP

• Clinical Social Worker in Erie, PA
• Providers in Erie, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.