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General NPI Number Information
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NPI Number | 1245826601
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Entity Type | Individual
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Provider Name | SENECA JEAN UPHOLD LICSW
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Gender | Female
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Dates
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Enumeration Date | 12/18/2020
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 133 STAUNTON DR
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City | WESTON
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State | WV
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Zip | 26452
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Country | US
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Telephone | 304-269-9510
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Fax | 304-472-1341
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Provider Business Mailing Address
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Address Line | 37 W MAIN ST
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City | BUCKHANNON
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State | WV
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Zip | 26201
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Country | US
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Telephone | 304-473-5634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | BP00946090
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | DP00946090
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License Number State | WV
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