Leeann Wagner

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

37PC00483700 Issued in NJ

Practice address

18 Kings Hwy Ste 202
Middletown, NJ 07748-2509

Phone

(201) 522-5108

NPI assigned

Jun 10, 2009

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)

Not enrolled

State licenses

Practice roles

Locations

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.

• Leeann Wagner LLC

  • Professional Counselor
  • Middletown, NJ
  • NPI 1265970933
  NPD Authorized official

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

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583971200000",
    "number": "1336375856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 LEONARD AVE",
            "city": "LEONARDO",
            "state": "NJ",
            "postal_code": "077371742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 KINGS HWY STE 202",
            "city": "MIDDLETOWN",
            "state": "NJ",
            "postal_code": "077482509",
            "telephone_number": "201-522-5108"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "166 Main St",
            "address_purpose": "LOCATION",
            "city": "Matawan",
            "state": "NJ",
            "postal_code": "077473104",
            "country_code": "US",
            "telephone_number": "732-290-9040 x424",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "210 W Front St Ste 206A",
            "address_purpose": "LOCATION",
            "city": "Red Bank",
            "state": "NJ",
            "postal_code": "077011155",
            "country_code": "US",
            "telephone_number": "201-522-5108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "LEEANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-10",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00483700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Middletown, NJ
• Providers in Middletown, NJ by specialty
• Professional Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; 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.