Janis Ann Wagner, PH.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY2351PR Issued in MA

Practice address

521 Mount Auburn St
Suite 107-109
Watertown, MA 02472-4191

Phone

(617) 416-7815

Fax

(781) 719-5039

NPI assigned

Jan 23, 2007

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

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.

• Daniel Rutrick, MD, PC

  • Prescribing (Medical) Psychologist
  • Everett, MA
  • NPI 1336341502
  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402963200000",
    "number": "1306990627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 GROVE ST",
            "address_2": "UNIT 3",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021143408",
            "telephone_number": "617-416-7815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 MOUNT AUBURN ST",
            "address_2": "SUITE 107-109",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024724191",
            "telephone_number": "617-416-7815",
            "fax_number": "781-719-5039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JANIS",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2014-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "PY2351PR",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kiersha Marie Voll
• Stephanie Von Csiky-Sessoms
• Annie Ly Vong, PHARM. D.
• Audrey Wagner, PH.D.
• Audrey Susan Wagner, M.D.
• Mahnoor Wajid
• Harmony Walbridge
• Catherine M Walls, PT
• Warby Parker Inc.
• Sue B Warner, NP

• Psychologist in Watertown, MA
• Providers in Watertown, MA by specialty
• Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2014; 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.