Active NPI
Susan Bandler Wagner, LICSW
- Clinical Social Worker
- Newfane, VT
National Provider Identifier
1700901568
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 089-0000330
- Practice address
- 23 West Street
Newfane, VT 05345 - Phone
- (802) 365-9115
- NPI assigned
- Mar 20, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 089-0000330 | VT | Primary |
Addresses
Primary practice location
23 West Street
Newfane, VT 05345
Mailing address
PO Box 344
Newfane, VT 05345-0344
Phone (802) 365-9115
Other names 1
- Susan Bandler Wagner
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 089-0000330 | VT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406764800000",
"number": "1700901568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 344",
"city": "NEWFANE",
"state": "VT",
"postal_code": "053450344",
"telephone_number": "802-365-9115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 WEST STREET",
"city": "NEWFANE",
"state": "VT",
"postal_code": "05345",
"telephone_number": "802-365-9115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANDLER WAGNER",
"first_name": "SUSAN",
"name_prefix": "Ms.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-20",
"last_updated": "2014-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VT",
"license": "089-0000330",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "BANDLER WAGNER",
"credential": "LICSW",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Newfane, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.