Nicole S Wagner, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6025 Issued in OH

Practice address

29525 Chagrin Blvd Ste 313
Beachwood, OH 44122

Phone

(216) 548-5469

NPI assigned

Dec 4, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1295803476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26047 BYRON DR",
            "city": "NORTH OLMSTED",
            "state": "OH",
            "postal_code": "440701913",
            "telephone_number": "216-548-5469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29525 CHAGRIN BLVD STE 313",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "44122",
            "telephone_number": "216-548-5469"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20325 Center Ridge Rd",
            "address_2": "Suite 612",
            "address_purpose": "LOCATION",
            "city": "Rocky River",
            "state": "OH",
            "postal_code": "441163572",
            "country_code": "US",
            "telephone_number": "216-548-5469",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "NICOLE",
        "middle_name": "S",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "6025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Beachwood, OH
• Providers in Beachwood, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; 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.