Kelly Marie Wagner, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C018909 Issued in NC

Practice address

1932 Brooksboro Dr
Erie, PA 16510-3872

Phone

(814) 708-2010

NPI assigned

Dec 13, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Western North Carolina Community Health Services Inc.

  • Federally Qualified Health Center (FQHC)
  • Asheville, NC
  • NPI 1780801050
  Medicare reassignment NPD
• Western North Carolina Community Health Services, Inc.

  • Community Health Clinic/Center
  • Asheville, NC
  • NPI 1043392921
  NPD
• Western North Carolina Community Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Marion, NC
  • NPI 1790402345
  NPD
• Apogee Behavioral Medicine PC

  • Psychiatry Physician
  • Greensboro, NC
  • NPI 1134868300
  NPD (past)
• Cotswold Clinician Support Services

  • Community/Behavioral Health Agency
  • Charlotte, NC
  • NPI 1063893568
  NPD (past)

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

{
    "created_epoch": "1639353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764633600000",
    "number": "1992464465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1932 BROOKSBORO DR",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165103872",
            "telephone_number": "814-490-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1932 BROOKSBORO DR",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165103872",
            "telephone_number": "814-708-2010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "77 Central Ave Ste D",
            "address_purpose": "LOCATION",
            "city": "Asheville",
            "state": "NC",
            "postal_code": "288014256",
            "country_code": "US",
            "telephone_number": "828-333-9320",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-13",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C018909",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "C018909",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Wachter
• Wade a. Shaffer D.C. Inc.
• Wagner Behavioral Health Services, LLC
• Julia Alexandra Wagner, PA-C
• Kayleigh Wagner, LAT, ATC
• Linda Wagner
• Molly Marie Wagner, LCSW
• Richard John Wagner Jr., DO
• Marlene Wahlster
• Allison J Wahoff, D.O.

• Clinical Social Worker in Erie, PA
• Providers in Erie, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.