Provider Demographics
NPI:1649642752
Name:WAGNER, DANIELLE (LSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 KAVANAUGH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-3010
Mailing Address - Country:US
Mailing Address - Phone:267-342-0023
Mailing Address - Fax:
Practice Address - Street 1:4 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1314
Practice Address - Country:US
Practice Address - Phone:215-757-6916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132986104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker