Provider Demographics
NPI:1124273412
Name:YARGER-WAGNER, LINDSY KAE (PSYD)
Entity type:Individual
Prefix:
First Name:LINDSY
Middle Name:KAE
Last Name:YARGER-WAGNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 ANCHOR WAY STE 9
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4692
Mailing Address - Country:US
Mailing Address - Phone:340-719-7007
Mailing Address - Fax:340-719-6655
Practice Address - Street 1:5030 ANCHOR WAY STE 9
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4692
Practice Address - Country:US
Practice Address - Phone:340-719-7007
Practice Address - Fax:340-719-6655
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI09-28-PSY103T00000X
PAPS016535103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist