Provider Demographics
NPI:1184784589
Name:MAUTNER, BARBARA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:MARIE
Last Name:MAUTNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37632 S. MASHIE DR.
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739
Mailing Address - Country:US
Mailing Address - Phone:520-818-0842
Mailing Address - Fax:520-877-3339
Practice Address - Street 1:37632 S. MASHIE DR.
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739
Practice Address - Country:US
Practice Address - Phone:520-818-0842
Practice Address - Fax:520-877-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LCSW2452101YM0800X
AZLCSW24521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ61894Medicare ID - Type Unspecified