Provider Demographics
NPI:1740204080
Name:WAGNER, ROSE BARTLER (MSS, LCSW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:BARTLER
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 MARYLAND CIR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3800
Mailing Address - Country:US
Mailing Address - Phone:484-557-1412
Mailing Address - Fax:610-873-2779
Practice Address - Street 1:1131 MARYLAND CIR
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3800
Practice Address - Country:US
Practice Address - Phone:484-557-1412
Practice Address - Fax:610-873-2779
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0153571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical