Provider Demographics
NPI:1528480274
Name:WAGNER, KRISTIN BEHRENS (MA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:BEHRENS
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 E HAVERFORD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3845
Mailing Address - Country:US
Mailing Address - Phone:267-295-2225
Mailing Address - Fax:610-527-8672
Practice Address - Street 1:940 E HAVERFORD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3845
Practice Address - Country:US
Practice Address - Phone:267-295-2225
Practice Address - Fax:610-527-8672
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health