Provider Demographics
NPI:1013409671
Name:WAGNER MAGGITTI, HEIDI CHRISTINE (MA, LMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:CHRISTINE
Last Name:WAGNER MAGGITTI
Suffix:
Gender:F
Credentials:MA, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 HARTWELL RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-1703
Mailing Address - Country:US
Mailing Address - Phone:716-410-1980
Mailing Address - Fax:
Practice Address - Street 1:374 DELAWARE AVE STE 210
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1611
Practice Address - Country:US
Practice Address - Phone:716-249-4041
Practice Address - Fax:716-608-1511
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3568101YM0800X
NY011765101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health