| Mind Body Soul - Psychology And Consulting Group Llc | |
|
109 Danbury Road Lower Level, Suite D6 Ridgefield CT 06877-0687 | |
| (203) 494-8468 | |
| (845) 582-0764 |
| Full Name | Mind Body Soul - Psychology And Consulting Group Llc |
|---|---|
| Speciality | Psychologist |
| Location | 109 Danbury Road, Ridgefield, Connecticut |
| Authorized Official Name and Position | Lori Wagner (OWNER, CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 2034948468 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Body Soul - Psychology And Consulting Group Llc 109 Danbury Road Lower Level, Suite D6 Ridgefield CT 06877 Ph: (203) 494-8468 | Mind Body Soul - Psychology And Consulting Group Llc 109 Danbury Road Lower Level, Suite D6 Ridgefield CT 06877-0687 Ph: (203) 494-8468 |
| NPI Number | 1912434234 |
|---|---|
| Provider Enumeration Date | 05/17/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 4789953852 |
|---|---|
| Medicare Enrollment ID | O20170705001374 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912434234 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2706 (Connecticut) | Primary |
| Provider Name | Lori Brooke Wagner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285902387 PECOS PAC ID: 5991962813 Enrollment ID: I20120206000174 |
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