Active NPI
Lucas Bosco Wanga, PH.D.
- Cognitive & Behavioral Psychologist
- Saint Paul, MN
National Provider Identifier
1881015253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- 362637
- Practice address
- 715 Edgerton Street
Merrick Community Services
St. Paul, MN 55130 - Phone
- (612) 360-1966
- NPI assigned
- Jan 2, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 362637 | MN | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 362637 | MN | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 362637 | MN | |
| School Psychologist | 103TS0200X | 362637 | MN |
Addresses
Primary practice location
715 Edgerton Street
Merrick Community Services
St. Paul, MN 55130
Mailing address
1311 4TH Street South East Suite 13531
Wanga & Associates
Minneapolis, MN 55414
Phone (612) 360-1966
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 362637 | MN | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1388620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388620800000",
"number": "1881015253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1311 4TH STREET SOUTH EAST SUITE 13531",
"address_2": "WANGA & ASSOCIATES",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55414",
"telephone_number": "612-360-1966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 EDGERTON STREET",
"address_2": "MERRICK COMMUNITY SERVICES",
"city": "ST. PAUL",
"state": "MN",
"postal_code": "55130",
"telephone_number": "612-360-1966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANGA",
"first_name": "LUCAS",
"middle_name": "BOSCO",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-02",
"last_updated": "2014-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "MN",
"license": "362637",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MN",
"license": "362637",
"primary": false
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "MN",
"license": "362637",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "MN",
"license": "362637",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.