Provider Demographics
NPI:1942918602
Name:MUTTON, JAMES SAMUEL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:SAMUEL
Last Name:MUTTON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E NEW YORK AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1293
Mailing Address - Country:US
Mailing Address - Phone:347-381-5981
Mailing Address - Fax:347-381-5990
Practice Address - Street 1:805 E NEW YORK AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1293
Practice Address - Country:US
Practice Address - Phone:347-381-5981
Practice Address - Fax:347-381-5990
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072029104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker