Provider Demographics
NPI:1770602096
Name:WAGNER, ANNE M (LSW)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:M
Last Name:WAGNER
Suffix:
Gender:F
Credentials:LSW
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 16
Mailing Address - Street 2:
Mailing Address - City:CORINNA
Mailing Address - State:ME
Mailing Address - Zip Code:04928-0016
Mailing Address - Country:US
Mailing Address - Phone:207-278-7630
Mailing Address - Fax:
Practice Address - Street 1:98 MAIN ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1146
Practice Address - Country:US
Practice Address - Phone:207-858-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELS10780104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker