Wagner Behavioral Health Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

CW015648 Issued in PA

Legal business name

WAGNER BEHAVIORAL HEALTH SERVICES, LLC

Practice address

1001 State St Ste 102
Erie, PA 16501-1835

Phone

(814) 580-1743

Fax

(814) 240-6347

NPI assigned

Feb 17, 2011

Last updated

Jul 26, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Paul Kearney

Title

Medical Billing Specialist

Phone

(814) 580-1743

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffery D. Boyles, MSW, LSW

  • Social Worker
  • Erie, PA
  • NPI 1972953529
  NPD
• Aaron Joseph Hart, LCSW

  • Clinical Social Worker
  • Erie, PA
  • NPI 1760958839
  NPD
• Zachary D Mota

  • Behavior Technician
  • Erie, PA
  • NPI 1811766801
  NPD
• Melissa J Eimers, LCSW

  • Social Worker
  • Erie, PA
  • NPI 1720660947
  NPD (past)

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

{
    "created_epoch": "1297900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564099200000",
    "number": "1548567175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 STATE ST STE 102",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165011835",
            "telephone_number": "814-580-1743",
            "fax_number": "814-240-6347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 STATE ST STE 102",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165011835",
            "telephone_number": "814-580-1743",
            "fax_number": "814-240-6347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGNER BEHAVIORAL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-17",
        "last_updated": "2019-07-26",
        "status": "A",
        "authorized_official_last_name": "KEARNEY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "MEDICAL BILLING SPECIALIST",
        "authorized_official_telephone_number": "814-580-1743"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "CW015648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102243824",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vroxantel LLC
• Corey Vukovic
• Jennifer Vuong, PHARM.D.
• Emily Wachter
• Wade a. Shaffer D.C. Inc.
• Julia Alexandra Wagner, PA-C
• Kayleigh Wagner, LAT, ATC
• Kelly Marie Wagner, LCSW
• Linda Wagner
• Molly Marie Wagner, LCSW

• Community/Behavioral Health Agency in Erie, PA
• Providers in Erie, PA by specialty
• Community/Behavioral Health Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2019; 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.