Healthcare Provider Details

I. General information

NPI: 1285502740
Provider Name (Legal Business Name): AMANDA ELAINE CATHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10932 SENEDO RD
MOUNT JACKSON VA
22842-2317
US

IV. Provider business mailing address

10932 SENEDO RD
MOUNT JACKSON VA
22842-2317
US

V. Phone/Fax

Practice location:
  • Phone: 570-404-8113
  • Fax:
Mailing address:
  • Phone: 570-404-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0813001296
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: