Provider Demographics
NPI:1003129529
Name:WAGNER, MARY CATHERINE (MS, CAGS, LMHC)
Entity type:Individual
Prefix:MS
First Name:MARY CATHERINE
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MS, CAGS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 796
Mailing Address - Street 2:
Mailing Address - City:ASHBURNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01430-0796
Mailing Address - Country:US
Mailing Address - Phone:978-827-1247
Mailing Address - Fax:
Practice Address - Street 1:27 WATER ST
Practice Address - Street 2:#107B
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3032
Practice Address - Country:US
Practice Address - Phone:978-827-1247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4956101YM0800X
MA369291103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool