Provider Demographics
NPI:1497357222
Name:GAGEBY, AMANDA SUE (LSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:GAGEBY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 FISHER HILL FARM LN
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-5277
Mailing Address - Country:US
Mailing Address - Phone:304-279-2553
Mailing Address - Fax:
Practice Address - Street 1:208 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9219
Practice Address - Country:US
Practice Address - Phone:304-263-5680
Practice Address - Fax:304-267-1532
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP009432461041C0700X
AP00943246104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical