Provider Demographics
NPI:1366512659
Name:WAGNER, KERI-ANN (MED, LMHC)
Entity type:Individual
Prefix:MRS
First Name:KERI-ANN
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 TURNPIKE ST, #2-1C
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1776
Mailing Address - Country:US
Mailing Address - Phone:508-219-2904
Mailing Address - Fax:
Practice Address - Street 1:448 TURNPIKE ST, #2-1C
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1776
Practice Address - Country:US
Practice Address - Phone:508-219-2904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health