Provider Demographics
NPI:1225264195
Name:MATTAINO, ALETA ANNAMARIE (MA, LMHC, NC)
Entity Type:Individual
Prefix:
First Name:ALETA
Middle Name:ANNAMARIE
Last Name:MATTAINO
Suffix:
Gender:F
Credentials:MA, LMHC, NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16727 45TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5615
Mailing Address - Country:US
Mailing Address - Phone:206-948-6844
Mailing Address - Fax:206-695-2302
Practice Address - Street 1:927 N NORTHLAKE WAY STE 220
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8871
Practice Address - Country:US
Practice Address - Phone:206-948-6844
Practice Address - Fax:206-695-2302
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2043358Medicaid