Provider Demographics
NPI:1659712875
Name:WAGNER, ARTHUR LINN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:LINN
Last Name:WAGNER
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:ARTHUR
Other - Middle Name:LINN ZOLLER
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:200 OAK DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-4973
Mailing Address - Country:US
Mailing Address - Phone:433-867-8422
Mailing Address - Fax:
Practice Address - Street 1:200 OAK DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4973
Practice Address - Country:US
Practice Address - Phone:433-867-8422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD189031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD898584Medicaid