Amanda Sue Charlton-Fryer, PSYD

Individual provider Active NPI Psychologist · Clarksburg, WV

NPI 1104148436 · NPPES record last updated Feb 23, 2011

Key facts

NPI
1104148436
Entity type
Individual (NPI type 1)
Primary specialty
Psychologist 103T00000X
License
PS016963 (PA)
Practice address
1 Med Center Dr
Louis a. Johnson VA Medical Center Mental Health Clinic
Clarksburg, WV 26301-4155
Phone
(304) 623-3461
NPI assigned
Mar 1, 2010
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
PS016963PAMDPsychologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PS016963 PA Yes

Addresses

Primary practice location

1 Med Center Dr
Louis a. Johnson VA Medical Center Mental Health Clinic
Clarksburg, WV 26301-4155

Mailing address

1 Med Center Dr
Louis a. Johnson VA Medical Center Mental Health Clinic
Clarksburg, WV 26301-4155
Phone (304) 623-3461

Other names

  • Ms. Amanda Sue Charlton Former name

Other providers in Clarksburg, WV

All providers in Clarksburg, WV · Psychologist in West Virginia

Sources for this page

Verify at the official NPI Registry.