Provider Demographics
NPI:1285138628
Name:WAGNER, LAUREN ELIZABETH (MS, BCBA, LBS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MS, BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 FREEDOM BUSINESS CTR DR STE 220
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1376
Mailing Address - Country:US
Mailing Address - Phone:440-242-9182
Mailing Address - Fax:
Practice Address - Street 1:3424 WILLIAM PENN HWY STE 215
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-5444
Practice Address - Country:US
Practice Address - Phone:440-242-9182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
PABH006342103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator