Provider Demographics
NPI:1841735784
Name:WAGNER, LYNN ZAMMIT (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ZAMMIT
Last Name:WAGNER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 77TH AVE N
Mailing Address - Street 2:STE 56546
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-5299
Mailing Address - Country:US
Mailing Address - Phone:727-954-5401
Mailing Address - Fax:
Practice Address - Street 1:701 77TH AVE N
Practice Address - Street 2:STE 56546
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5299
Practice Address - Country:US
Practice Address - Phone:727-954-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-14-17180103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst