Provider Demographics
NPI:1346099546
Name:WAGERMAN, SETH (PHD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:WAGERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93062-0494
Mailing Address - Country:US
Mailing Address - Phone:657-206-2402
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 494
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93062-0494
Practice Address - Country:US
Practice Address - Phone:657-206-2402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-18
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34847103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist