Provider Demographics
NPI:1841244522
Name:MAUTZ, WILLIAM THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:MAUTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:20 LADD ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4089
Mailing Address - Country:US
Mailing Address - Phone:603-334-3311
Mailing Address - Fax:603-433-6341
Practice Address - Street 1:20 LADD ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4089
Practice Address - Country:US
Practice Address - Phone:603-334-3311
Practice Address - Fax:603-433-6341
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH963103G00000X
MA7826103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist