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Contact Information

JEFFREY M WAGNER, PHD
500 MARKET STREET 1-G
PORTSMOUTH, NH03801
 Phone: 603-427-1428
 Fax: 603-431-5538
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for JEFFREY M WAGNER · (Male)

NPI Number 1760521843
Status Active
Credentials PHD
Entity Individual
Enumeration date 02/06/2007
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • NH License # 396
  • NH Medicaid 80000875
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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