Provider Demographics
NPI:1538913835
Name:SELENOU, FRIDA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:FRIDA
Middle Name:
Last Name:SELENOU
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FOXCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-5302
Mailing Address - Country:US
Mailing Address - Phone:304-443-1408
Mailing Address - Fax:
Practice Address - Street 1:400 FOXCROFT AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-5302
Practice Address - Country:US
Practice Address - Phone:304-443-1408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR226630363LP0808X
WV120466363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health