AUDREY WAGNER PH.D.
NPI 1922047679
Psychologist - Clinical in Watertown, MA

Q: What is Audrey Wagner's NPI number?

The NPI number for Audrey Wagner is 1922047679. It was assigned to this individual provider in the NPPES registry on June 6, 2006.

Q: What is Audrey Wagner's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: Is Audrey Wagner enrolled in Medicare?

No. Audrey Wagner has opted out of Medicare through May 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Audrey Wagner was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years 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 June 06, 2006Opted out of Medicare · through May 1, 2028

173 MOUNT AUBURN ST, WATERTOWN, MA 02472(617) 923-2468 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Audrey Wagner Ph.d. NPPES

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

AUDREY WAGNER PH.D. (NPI 1922047679) is an individual clinical provider in Watertown, Massachusetts, licensed in Massachusetts (4685) and active in the NPI registry since June 2006. She has opted out of Medicare through May 1, 2028.

NPPES Registry Identity

NPI1922047679

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameAUDREY WAGNERCredential: PH.D.

Location Address173 MOUNT AUBURN STWatertown, MA 02472-4005

Mailing Address173 Mount Auburn StWatertown, MA 02472-4005

Phone(617) 923-2468

Sole ProprietorYes

Enumeration DateJune 6, 2006

Last NPPES UpdateJuly 8, 2007

✔ NPI 1922047679 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in MA · 4685

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

173 MOUNT AUBURN ST, Watertown, MA 02472

Open in Google Maps ↗

Other Identifiers 2

Medicare ID-Type UnspecifiedW04524MA

OtherW04524MA · Bcbs

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Audrey Wagner Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from May 1, 2020 through May 1, 2028.

Opt-Out Effective DateMay 1, 2020

Opt-Out In Effect ThroughMay 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 15

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

MS. JANICE STUBBLEFIELD-TAVE MA, LICSW

Social Worker (Clinical)