Blake Douglas Wagner Jr., PH.D.
NPI 1013069061ActiveIndividual· Psychologist· Mansfield, OH
Psychologist (PH.D.) with New Directions Eap Inc, practicing in Mansfield, Ohio. Enrolled in Medicare as practitioner - clinical psychologist.
Overview
| NPI | 1013069061 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PH.D. |
| Sole proprietor | No |
| NPI issued | Jan 18, 2007 |
| Last updated in NPPES | Sep 2, 2008 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist Primary | 103T00000X | I-4127 | OH |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Psychologist (OH) |
|---|
Education and affiliations
| Graduation year | 1988 |
|---|---|
| Medicare specialty | Clinical Psychologist |
| Telehealth | Offers telehealth |
Medical group
- New Directions Eap IncMansfield, OH · 3 clinicians
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