Provider Demographics
NPI:1225396047
Name:WAGNER, JUSTINE
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 PENN AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1768
Mailing Address - Country:US
Mailing Address - Phone:412-852-2334
Mailing Address - Fax:412-204-9134
Practice Address - Street 1:5231 PENN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1768
Practice Address - Country:US
Practice Address - Phone:412-852-2334
Practice Address - Fax:412-204-9134
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health