Provider Demographics
NPI:1013485846
Name:MAMONT, AUSTIN NICHOLAS (LICSW)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:NICHOLAS
Last Name:MAMONT
Suffix:
Gender:U
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 W RIVERSIDE AVE # 8522
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0580
Mailing Address - Country:US
Mailing Address - Phone:206-451-7284
Mailing Address - Fax:
Practice Address - Street 1:522 W RIVERSIDE AVE # 8522
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0580
Practice Address - Country:US
Practice Address - Phone:206-451-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW615500201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical