Provider Demographics
NPI:1477689685
Name:STOUT, KAREN LESLIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LESLIE
Last Name:STOUT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 WASHINGTON ST
Mailing Address - Street 2:APT GB
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3323
Mailing Address - Country:US
Mailing Address - Phone:917-608-4919
Mailing Address - Fax:
Practice Address - Street 1:626 WASHINGTON ST
Practice Address - Street 2:APT GB
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3323
Practice Address - Country:US
Practice Address - Phone:917-608-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical