Provider Demographics
NPI:1184672552
Name:WAGNER, REBECCA DEHAVEN (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DEHAVEN
Last Name:WAGNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 MCKNIGHT RD STE 308
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-6000
Mailing Address - Country:US
Mailing Address - Phone:412-495-2890
Mailing Address - Fax:
Practice Address - Street 1:9401 MCKNIGHT RD STE 308
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-6000
Practice Address - Country:US
Practice Address - Phone:412-495-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0153211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical