Gerald Wagner Jr., LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

000326 Issued in CT

Practice address

21 Montauk Ave
New London, CT 06320-4906

Phone

(860) 271-4715

Fax

(860) 271-4797

NPI assigned

Aug 8, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: gerald.wagner@xdr.hhchealthdirect.org
• FHIR API: https://api.qualifacts.org/api/fhir/soundcommunityservices/r4/

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.

• Sound Community Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New London, CT
  • NPI 1396700886
  NPD (past)

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

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482278400000",
    "number": "1962759084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 390",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063200390",
            "telephone_number": "860-271-4715",
            "fax_number": "860-271-4797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204906",
            "telephone_number": "860-271-4715",
            "fax_number": "860-271-4797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "GERALD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-08",
        "last_updated": "2016-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "000326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Villegas, DO
• Alexis Yahir Vitorino
• Reilly Anne Voit, PA-C
• Rachel Volke, MD
• Andrea Vuono, MS, CCC-SLP
• Janice Waid, MFT
• Timothy G Waksmonski
• Maturin Frye Waldo, LCSW-R
• Walgreen Co (Walgreens #11606)
• Walgreen Co (Rite Aid)

• Addiction (Substance Use Disorder) Counselor in New London, CT
• Providers in New London, CT by specialty
• Addiction (Substance Use Disorder) Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2016; 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.