Provider Demographics
NPI:1255629184
Name:WAGNER, JOYCE (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ALLENS CREEK RD
Mailing Address - Street 2:BUILDING 1, SUITE 323
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3250
Mailing Address - Country:US
Mailing Address - Phone:585-733-9465
Mailing Address - Fax:
Practice Address - Street 1:95 ALLENS CREEK RD
Practice Address - Street 2:BUILDING 1, SUITE 323
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3250
Practice Address - Country:US
Practice Address - Phone:585-733-9465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0763701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical