Nancy Wagner-Wetzel, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

7876 Issued in NY

Practice address

148 Jacques Ave
Staten Island, NY 10306-3028

Phone

(917) 797-9441

NPI assigned

Jun 13, 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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: nancy.wagnerwetzel@iclhcc.eclinicaldirectplus.com

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.

• Health Care Choices Ny Inc

  • Federally Qualified Health Center (FQHC)
  • Brooklyn, NY
  • NPI 1770521270
  Medicare reassignment NPD
• Adult Care Psychology Services, PLLC

  • Clinical Psychologist
  • Flushing, NY
  • NPI 1609935444
  NPD (past)

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334793600000",
    "number": "1467495952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 ALAN LOOP",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103044434",
            "telephone_number": "718-816-7102",
            "fax_number": "718-816-7102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 JACQUES AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103063028",
            "telephone_number": "917-797-9441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER-WETZEL",
        "first_name": "NANCY",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-13",
        "last_updated": "2012-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "7876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00979424",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "680408",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• VZ Optical
• Nelisha Waas, OTR/L
• Shayna E Wacholder
• Brittany N Waddy
• Amanda Wagerik-Fasano, LMSW, CASAC-T
• Candice Ashley Wagner, RN
• Debra Wagner
• Maung Tint Wai, MD
• George Wakeham
• Veronica Wakeman, LPN

• Clinical Psychologist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.