Most Relevant Information
Provider Data
| NPI Number: | 1003522749 |
| Provider Name: | BRENDAN MATTHIAS WAGNER RBT |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | RBT-23-253124 |
Most Important Dates
| Enumeration Date: | 01/26/2023 |
| Last Updated: | 01/26/2023 |
Provider Practice Location
293 INDEPENDENCE BLVD STE 400
VIRGINIA BEACH
VA
234625461
Practice Location Phone/Fax
| Phone: | 7577853338 |
| Fax: |
Provider Mailing Location
293 INDEPENDENCE BLVD STE 400
VIRGINIA BEACH
VA
234625461
Provider Mailing Phone/Fax
| Phone: | 7577853338 |
| Fax: |