Provider Demographics
NPI:1205515624
Name:MAUTONE, JAX (CT)
Entity type:Individual
Prefix:
First Name:JAX
Middle Name:
Last Name:MAUTONE
Suffix:
Gender:M
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1933
Mailing Address - Country:US
Mailing Address - Phone:740-314-0010
Mailing Address - Fax:740-996-4199
Practice Address - Street 1:517 N 4TH ST
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1933
Practice Address - Country:US
Practice Address - Phone:740-314-0010
Practice Address - Fax:740-996-4199
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor