KENYADA MARIE WAGONER LCSW
NPI 1760172688
Social Worker - Clinical in Riverside, CA

Q: What is Kenyada Wagoner's NPI number?

The NPI number for Kenyada Wagoner is 1760172688. It was assigned to this individual provider in the NPPES registry on May 12, 2023.

Q: What is Kenyada Wagoner's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Kenyada Wagoner was last updated on August 18, 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.

Active since May 12, 2023PECOS Enrolled

4361 LATHAM ST STE 220, RIVERSIDE, CA 92501(858) 279-1223 Get Directions Write a Review

NPPES record last updated: August 18, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 18, 2026, May 12, 2023 (2 updates tracked since 2023).

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About Kenyada Marie Wagoner Lcsw NPPES

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

KENYADA MARIE WAGONER LCSW (NPI 1760172688) is an individual clinical provider in Riverside, California, licensed in California (114731) and active in the NPI registry since May 2023. She is enrolled in Medicare PECOS and maintains a secondary practice location in San Bernardino.

NPPES Registry Identity

NPI1760172688

Entity TypeIndividualFemale

Primary Taxonomy1041C0700X

Provider Legal NameKENYADA MARIE WAGONERCredential: LCSW

Location Address4361 LATHAM ST STE 220Riverside, CA 92501-1767

Mailing Address315 E Esplanade Ave Unit 1581San Jacinto, CA 92583-5102 · (951) 214-5071

Phone(858) 279-1223

Sole ProprietorYes

Enumeration DateMay 12, 2023

Last NPPES UpdateAugust 18, 20262 updates tracked since enumeration

NPPES CertifiedAugust 18, 2026

✔ NPI 1760172688 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in CA · 114731

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

4361 LATHAM ST STE 220, Riverside, CA 92501

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Secondary Practice Location 1

Location 11906 Commercenter E Ste 210San Bernardino, CA 92408-3424 · Phone (909) 567-2575

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenyada Marie Wagoner Lcsw 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.

Medicare Billing Reassignments

Medicare enrollment records show Kenyada Wagoner reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Community Health Systems, Inc.

1.8 mi

Federally Qualified Health Center (FQHC)

2933 UNIVERSITY AVE
Riverside, CA 92507

Reassigned Medicare billing, California enrollment
86 clinicians in this Medicare group

NPI 1205102068 (951) 224-8220

Healing Haven Mental Health

30 mi

Clinical

1519 WASHINGTON AVE
San Jacinto, CA 92583

Reassigned Medicare billing, California enrollment

NPI 1922975978 (650) 559-4850

Pacific Coast Psychiatric Associates Inc

315 mi

Clinical

7373 N SCOTTSDALE RD STE A199
Scottsdale, AZ 85253

Reassigned Medicare billing, California enrollment
766 clinicians in this Medicare group

NPI 1023125465 (702) 805-5360

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92501 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$0.00 typical visit price

range $59.60 – $179.42

Typical copayment $0.00 (range $14.90 – $44.85)

Most-billed visit code NA

Established Patient

$74.08 typical visit price

range $19.37 – $146.42

Typical copayment $18.52 (range $4.84 – $36.60)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

KRYSTAL AMANDA VELASCO HERNANDEZ PMHNP

Nurse Practitioner (Psychiatric/Mental Health)