Matthew T. Wagner, CLIN. PSYCHOLOGIST

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY19277 Issued in CA

Practice address

21633 Avenue 24
Chowchilla, CA 93610-9650

Phone

(559) 665-6100

NPI assigned

Aug 20, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• California Department of Corrections &Rehabilitation

  • Rural Health Clinic/Center
  • Chowchilla, CA
  • NPI 1073710398
  NPD (past)
• State of California

  dba California Correctional Health Care Services

  • Prison Health Clinic/Center
  • Chowchilla, CA
  • NPI 1316322647
  NPD (past)

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

{
    "created_epoch": "1282262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282262400000",
    "number": "1811203417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21633 AVENUE 24",
            "city": "CHOWCHILLA",
            "state": "CA",
            "postal_code": "936109650",
            "telephone_number": "559-655-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21633 AVENUE 24",
            "city": "CHOWCHILLA",
            "state": "CA",
            "postal_code": "936109650",
            "telephone_number": "559-665-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MATTHEW",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "CLIN. PSYCHOLOGIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-20",
        "last_updated": "2010-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY19277",
            "primary": true
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "CA",
            "license": "PSY 19277",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "CA",
            "license": "PSY 19277",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "CA",
            "license": "PSY 19277",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "CA",
            "license": "PSY 19277",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Uchida
• Victor Valdivia Jr., ED.S, PPS
• Jon Peter Vandewalker, DDS, MS, FAGD, ABGD
• Pal Singh Virk, M.D.
• W Enterprising LLC (Ready Medical Transportation)
• Jennifer Renee Walker, D.C.
• Margareta Maria Wiberg X, PHD
• Xayvinay Xiong, PH.D.
• Melanie Yee
• George K Yousefi

• Clinical Psychologist in Chowchilla, CA
• Providers in Chowchilla, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2010; 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.