Provider Demographics
NPI:1760082945
Name:WAGGAMAN, NATALIE PIERPONT (LICSW)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:PIERPONT
Last Name:WAGGAMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-1516
Mailing Address - Country:US
Mailing Address - Phone:917-331-0528
Mailing Address - Fax:
Practice Address - Street 1:34 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-1516
Practice Address - Country:US
Practice Address - Phone:917-331-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical