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DR. ANDREA M WAGNER PSY.D.
NPI 1366995078
Psychologist - Addiction (Substance Use Disorder) in Newport Beach, CA

Active since July 28, 2016PECOS Enrolled
456 OLD NEWPORT BLVD, NEWPORT BEACH, CA 92663(949) 447-8257 Get Directions Write a Review

NPPES record last updated: May 21, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 21, 2026, May 9, 2026, May 2, 2024 and 2 more (5 updates tracked since 2023).

About Dr. Andrea M Wagner Psy.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ANDREA M WAGNER PSY.D. (NPI 1366995078) is an individual addiction (substance use disorder) provider in Newport Beach, California, licensed in California (32730) and active in the NPI registry since July 2016. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1366995078
Entity TypeIndividualFemale
Primary Taxonomy103TA0400X
Provider Legal NameDR. ANDREA M WAGNERCredential: PSY.D.
Location Address456 OLD NEWPORT BLVDNewport Beach, CA 92663-4211
Mailing Address456 Old Newport BlvdNewport Beach, CA 92663-4211 · (949) 447-8257
Phone(949) 447-8257
Sole ProprietorYes
Enumeration DateJuly 28, 2016
Last NPPES UpdateMay 21, 20265 updates tracked since enumeration
NPPES CertifiedMay 21, 2026
✔ NPI 1366995078 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPsychologist · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code103TA0400X
License✔ Licensed in CA · 32730
Definition
A psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral, interpersonal and other problems arising from the addictive behavior.
Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License 5083 (CT), 32730 (CA)
Also ListedPsychologist · Intellectual and Developmental DisabilitiesTaxonomy 103TM1800X · License 32730 (CA)
Also ListedPsychologist · RehabilitationTaxonomy 103TR0400X · License 5083 (CT), 32730 (CA)
456 OLD NEWPORT BLVD, Newport Beach, CA 92663
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Andrea M Wagner Psy.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDRE EVANS AMFT-122136
Marriage & Family Therapist
456 OLD NEWPORT BLVD
NEWPORT BEACH, CA 92663
Orange County (949) 781-9025
KAYLEE LYNN CRAFTON ASW
Social Worker
456 OLD NEWPORT BLVD
NEWPORT BEACH, CA 92663
Orange County (949) 781-9025
ANDREA M WAGNER PSYCHOLOGIST PC
Clinic/Center (Adult Mental Health)
456 OLD NEWPORT BLVD
NEWPORT BEACH, CA 92663
Orange County (949) 447-8257
REDEEMED MENTAL HEALTH LLC
Clinic/Center (Adult Mental Health)
456 OLD NEWPORT BLVD
NEWPORT BEACH, CA 92663
Orange County (949) 782-2254

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Andrea Wagner's NPI number?

The NPI number for Andrea Wagner is 1366995078. It was assigned to this individual provider in the NPPES registry on July 28, 2016.

Where is Andrea Wagner located?

Andrea Wagner practices at 456 Old Newport Blvd, Newport Beach, CA 92663. The listed phone number is (949) 447-8257.

What is Andrea Wagner's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Addiction (Substance Use Disorder), with taxonomy code 103TA0400X.

Is Andrea Wagner enrolled in Medicare?

Yes. Andrea Wagner is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Andrea Wagner was last updated on May 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.