Provider Demographics
NPI:1235402611
Name:LINDSY WAGNER LLC
Entity Type:Organization
Organization Name:LINDSY WAGNER LLC
Other - Org Name:ISLAND THERAPY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSY
Authorized Official - Middle Name:K
Authorized Official - Last Name:YARGER-WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:340-719-7007
Mailing Address - Street 1:5030 ANCHOR WAY
Mailing Address - Street 2:SUITES 5,7,9, 10
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820
Mailing Address - Country:US
Mailing Address - Phone:340-719-7007
Mailing Address - Fax:340-719-6655
Practice Address - Street 1:5030 ANCHOR WAY
Practice Address - Street 2:SUITES 5,7,9, 10
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-719-7007
Practice Address - Fax:340-719-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI09/028-PSY103G00000X
103G00000X, 1041C0700X
VI2-14480-1B1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty