Provider Demographics
NPI:1013485846
Name:MAMONT, AUSTIN NICHOLAS (LSWAIC)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:NICHOLAS
Last Name:MAMONT
Suffix:
Gender:M
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12345 LAKE CITY WAY NE # 2180
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5401
Mailing Address - Country:US
Mailing Address - Phone:206-451-7284
Mailing Address - Fax:
Practice Address - Street 1:3592 NE 73RD PL APT 7A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5955
Practice Address - Country:US
Practice Address - Phone:206-451-7284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC611983231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical