Imani Tacuma Wagstaff I

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

1 Mustard St
Rochester, NY 14609-6980

Phone

(585) 256-7500

NPI assigned

Dec 29, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1514505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1578070512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MUSTARD ST",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146096980",
            "telephone_number": "585-256-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MUSTARD ST",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146096980",
            "telephone_number": "585-256-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Portland Ave Ste 54",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146213014",
            "country_code": "US",
            "telephone_number": "585-470-9224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGSTAFF",
        "first_name": "IMANI",
        "middle_name": "TACUMA",
        "name_suffix": "I",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-29",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Wagner, LMHC
• Joyce Wagner, PH.D., LCSW
• Judit Wagner, M.D.
• Kelsey Huxtable Wagner, FNP
• Robin Lisa Wagner, MD
• Oumou Wague, LMHC
• Eman Wahba, MD
• Catherine Elizabeth Wahl, RN
• Marley Jane Wahl
• Lisa Wahlers, CRNA

• Counselor in Rochester, NY
• Providers in Rochester, NY by specialty
• Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; 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.