Provider Demographics
NPI:1649151242
Name:MUTIVITO, ADOLPHINE R
Entity type:Individual
Prefix:MISS
First Name:ADOLPHINE
Middle Name:R
Last Name:MUTIVITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:MUTIVITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4397 LE MARIE CT APT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1463
Mailing Address - Country:US
Mailing Address - Phone:614-556-0225
Mailing Address - Fax:
Practice Address - Street 1:4397 LE MARIE CT APT A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1463
Practice Address - Country:US
Practice Address - Phone:614-556-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health