Provider Demographics
NPI:1942078787
Name:ANDREW WAGENSELLER LCSW, LLC
Entity Type:Organization
Organization Name:ANDREW WAGENSELLER LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGENSELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-434-6907
Mailing Address - Street 1:78 CENTERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-3404
Mailing Address - Country:US
Mailing Address - Phone:203-434-6907
Mailing Address - Fax:
Practice Address - Street 1:2507 POST RD FL 3
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1259
Practice Address - Country:US
Practice Address - Phone:203-307-5330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health