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Contact Information

ANDREA M WAGNER, PSY.D.
456 OLD NEWPORT BLVD
NEWPORT BEACH, CA92663-4211
 Phone: 949-447-8257
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Addiction (Substance Use Disorder)

103TA0400X 62 Psychologist, Clinical
 

Clinical

103TC0700X 62 Psychologist, Clinical
 

Intellectual & Developmental Disabilities

103TM1800X 62 Psychologist, Clinical
 

Rehabilitation

103TR0400X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for ANDREA M WAGNER · (Female)

NPI Number 1366995078
Status Active
Credentials PSY.D. (Doctor of Psychology)
Entity Individual
Enumeration date 07/28/2016
Last updated 05/21/2026 - About 2 weeks ago
Sole proprietor 1 Yes
Identifiers
  • CA License # 32730
  • CT License # 5083
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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