MEDICARE: MS. AMANDA E. MESSENGER LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	DP00943809	WV

General Provider Information

NPI Number	:	1174094973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA E. MESSENGER LICSW

Provider Business Mailing Address
First Line	:	PO BOX 399
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-0399
Country	:	US
Telephone Number	:	304-265-0312
Fax Number	:	304-265-0314

Provider Business Practice Location Address
First Line	:	83 POPLAR ST
Second Line	:
City	:	ROWLESBURG
State	:	WV
Zip	:	26425-1124
Country	:	US
Telephone Number	:	304-454-2421
Fax Number	:	304-454-9690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	01/15/2025

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