Provider Demographics
NPI:1528285061
Name:MUTO, NICHOLAS JOSEPH (MS)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JOSEPH
Last Name:MUTO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2527
Mailing Address - Country:US
Mailing Address - Phone:570-586-7366
Mailing Address - Fax:570-586-7366
Practice Address - Street 1:513 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-2527
Practice Address - Country:US
Practice Address - Phone:570-586-7366
Practice Address - Fax:570-586-7366
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008151103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool