Lori Wagner, PSY.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

2706 Issued in CT

Practice address

109 Danbury Road
Lower Level, Suite D6
Ridgefield, CT 06877

Phone

(203) 494-8468

Fax

(845) 582-0764

NPI assigned

Dec 5, 2011

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 CT

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

Nova Southeastern Univ College of Dental Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Mind Body Soul - Psychology and Consulting Group LLC

  • Clinical Psychologist
  • Ridgefield, CT
  • NPI 1912434234
  Medicare reassignment Authorized official
• Nuvance Health Medical Practice CT, Inc.

  • Internal Medicine Physician
  • Danbury, CT
  • NPI 1407898117
  NPD (past)

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

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495065600000",
    "number": "1285902387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 DANBURY ROAD",
            "address_2": "LOWER LEVEL, SUITE D6",
            "city": "RIDGEFIELD",
            "state": "CT",
            "postal_code": "068770687",
            "telephone_number": "203-494-8468",
            "fax_number": "845-582-0764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 DANBURY ROAD",
            "address_2": "LOWER LEVEL, SUITE D6",
            "city": "RIDGEFIELD",
            "state": "CT",
            "postal_code": "06877",
            "telephone_number": "203-494-8468",
            "fax_number": "845-582-0764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "LORI",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-05",
        "last_updated": "2017-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CT",
            "license": "2706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle P Vincoli-Diroma, MS, LPC
• Ronald Vollen, P.T.
• Linda Vossler
• W&J Home Care, LLC
• Jeanette Waegelein, RDN
• Karen Walant, PHD
• Walgreen Co
• Walgreen Co
• Kristen Elizabeth Walsh, BCBA
• Shannon Wargo

• Clinical Neuropsychologist in Ridgefield, CT
• Providers in Ridgefield, CT by specialty
• Clinical Neuropsychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2017; 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.