Provider Demographics
NPI:1609342328
Name:ZEIDERS, AMY ELIZABETH (LICSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:ZEIDERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:BLACKSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26521-0072
Mailing Address - Country:US
Mailing Address - Phone:304-432-8211
Mailing Address - Fax:304-432-8213
Practice Address - Street 1:1226 KINGS RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-9155
Practice Address - Country:US
Practice Address - Phone:304-432-8209
Practice Address - Fax:304-432-8213
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00943072104100000X
WVDP009430721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker