Active NPI
Megan L. Wagner, PH.D.
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1285082354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 27426
- Practice address
- 5757 Wilshire Blvd Ste 439
Los Angeles, CA 90036-3628 - Phone
- (310) 579-9335
- NPI assigned
- May 31, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 | 27426 | CA | Primary |
Addresses
Primary practice location
5757 Wilshire Blvd Ste 439
Los Angeles, CA 90036-3628
Mailing address
5757 Wilshire Blvd Ste 439
Los Angeles, CA 90036-3628
Phone (310) 579-9335
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 5, 2024 through Aug 5, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27426 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574380800000",
"number": "1285082354",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5757 WILSHIRE BLVD STE 439",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900363628",
"telephone_number": "310-579-9335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5757 WILSHIRE BLVD STE 439",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900363628",
"telephone_number": "310-579-9335"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "MEGAN",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-05-31",
"last_updated": "2019-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "27426",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.