| Wagner Behavioral Health Services, Llc | |
|
1001 State St Ste 102 Erie PA 16501-1835 | |
| (814) 580-1743 | |
| (814) 240-6347 |
| Full Name | Wagner Behavioral Health Services, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1001 State St Ste 102, Erie, Pennsylvania |
| Authorized Official Name and Position | Paul Kearney (MEDICAL BILLING SPECIALIST) |
| Authorized Official Contact | 8145801743 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wagner Behavioral Health Services, Llc 1001 State St Ste 102 Erie PA 16501-1835 Ph: (814) 580-1743 | Wagner Behavioral Health Services, Llc 1001 State St Ste 102 Erie PA 16501-1835 Ph: (814) 580-1743 |
| NPI Number | 1548567175 |
|---|---|
| Provider Enumeration Date | 02/17/2011 |
| Last Update Date | 07/26/2019 |
| Medicare PECOS PAC ID | 4486835410 |
|---|---|
| Medicare Enrollment ID | O20110224000382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548567175 | NPI | - | NPPES |
| 102243824 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | CW015648 (Pennsylvania) | Primary |
| Provider Name | Molly M Wagner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225240922 PECOS PAC ID: 3870625809 Enrollment ID: I20100715000178 |
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