NICOLE S. WAGNER, PH.D., LLC (NPI# 1053589135) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053589135 |
| Entity Type | Organization |
| Organization Name | NICOLE S. WAGNER, PH.D., LLC |
| Practice Address |
11740 Clifton Blvd Suite 202 Lakewood OH 44107-2057 |
| Practice Telephone | 2165485469 |
| Mailing Telephone | 2165485469 |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2008-02-12 |
| Authorized Official Name | DR. NICOLE S WAGNER (MANAGING PARTNER) |
| Authorized Official Telephone | 2165485469 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
6025 | OH | Behavioral Health & Social Service Providers |
| Street Address |
11740 CLIFTON BLVD SUITE 202 |
| City | LAKEWOOD |
| State | OH |
| Zip Code | 44107-2057 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326522210 | Lawrence M Roth | Social Worker | 14701 Detroit Ave Ste 363, Lakewood, OH 44107 | 2018-09-18 |
| 1376065730 | Fareeha Khan | Internal Medicine | 12540 Edgewater Drive, Apt 411, Lakewood, OH 44107 | 2017-07-07 |
| 1912433756 | Julie Ann Foucher-urcuyo | Family Medicine | 14601 Detroit Ave, Fl 2, Lakewood, OH 44107 | 2017-05-11 |
| 1225563661 | Elizabeth Ann Rainbolt | Family Medicine | 14601 Detroit Ave Fl 2, Lakewood, OH 44107 | 2017-04-24 |
| 1255882551 | Kristen Murray | Dietitian, Registered | 14900 Detroit Ave Ste 207, Lakewood, OH 44107 | 2016-10-21 |
| 1265828131 | David Thomas Jonke | Dentist | 15640 Madison Ave., Lakewood, OH 44107 | 2015-04-08 |
| 1760885941 | Debra Watkins | Home Health Aide | 1510 Newman Ave Apt 406, Lakewood, OH 44107 | 2014-10-02 |
| 1396155198 | Monica M Owen | Occupational Therapist | 9200 Biddulph Rd., Brooklyn, OH 44107 | 2014-05-01 |
| 1730512229 | Marsha Elaine Favors | Licensed Practical Nurse | 1448 Lakeland Ave, Lakewood, OH 44107 | 2013-08-20 |
| 1508130006 | Ruth Rachel Raciniewski | Counselor | 15200 Madison Avenue, Lakewood, OH 44107 | 2012-03-01 |
| Find all providers in zip 44107 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659996692 | Thrive Psychology Center, LLC | Psychologist | 699 Cross St Ste 110, Lakewood, NJ 08701-4681 | 2020-06-16 |
| 1578120960 | Eliyahu Melen | Psychologist | 1379 Alvarado Ave, Lakewood, NJ 08701-3902 | 2019-05-22 |
| 1548723190 | Jennifer Durst | Psychologist | 445 Union Blvd Ste 221, Lakewood, CO 80228-1241 | 2019-04-10 |
| 1093296261 | Kendra A Mathys Psyd LLC | Psychologist | 15644 Madison Ave Ste 202, Lakewood, OH 44107-5622 | 2018-08-27 |
| 1285137703 | Empower Health Center | Psychologist | 195 Walnut Ave, Lakewood, NJ 08701-5669 | 2018-03-11 |
| 1639607336 | Reine Evereteze, Psyd, LLC | Psychologist | 8015 W Alameda Ave Ste 230, Lakewood, CO 80226-3076 | 2017-05-25 |
| 1043686991 | Vincent Thomas Gollogly | Psychologist | 11444 Gravelly Lake Dr Sw, Lakewood, WA 98499-1404 | 2015-08-14 |
| 1710390299 | Mark Onusko | Psychologist | 2085 Wyandotte Ave, Lakewood, OH 44107-6135 | 2014-06-03 |
| 1093126369 | Elizabeth Ormond Ahlers | Psychologist | 1687 Cole Blvd Ste 103, Lakewood, CO 80401-3318 | 2014-05-08 |
| 1114346343 | Meshkin B Amirirad | Psychologist | 1492 S Jellison St, Lakewood, CO 80232-5025 | 2014-04-15 |
| Find all providers in LAKEWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.