NPIMap

Individual provider Active NPI

Daniel Ben Wagner, PSY.D.

  • Psychologist
  • Rockville, MD
National Provider Identifier
1790950798
Registry record updated Apr 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
04954 Issued in MD
Practice address
14808 Physicians LN
111
Rockville, MD 20850-3942
Phone
(301) 869-1017
Fax
(240) 235-4353
NPI assigned
Apr 29, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 017505 NY
Psychologist 103T00000X 04954 MD Primary

Addresses

Primary practice location

14808 Physicians LN
111
Rockville, MD 20850-3942

Mailing address

14808 Physicians LN
111
Rockville, MD 20850-3942
Phone (301) 869-1017

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
04954MDMDPsychologist
017505NYMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Expressive Therapy Center, LLC Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398643200000",
    "number": "1790950798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14808 PHYSICIANS LN",
            "address_2": "111",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503942",
            "telephone_number": "301-869-1017",
            "fax_number": "240-235-4353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14808 PHYSICIANS LN",
            "address_2": "111",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503942",
            "telephone_number": "301-869-1017",
            "fax_number": "240-235-4353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "DANIEL",
        "middle_name": "BEN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-29",
        "last_updated": "2014-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "017505",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MD",
            "license": "04954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.

Verify at the official NPI Registry.