Provider Demographics
NPI:1700475746
Name:MAUTINO, LINDSEY (LPC)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:MAUTINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GREENBRIAR CIR
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:PA
Mailing Address - Zip Code:16345-1202
Mailing Address - Country:US
Mailing Address - Phone:814-335-0865
Mailing Address - Fax:
Practice Address - Street 1:1885 MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-1277
Practice Address - Country:US
Practice Address - Phone:814-723-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012905101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC012905OtherBPOA