Provider Demographics
NPI:1194400770
Name:STOUT, MARIE-ALICE (LCADC, LSW)
Entity type:Individual
Prefix:
First Name:MARIE-ALICE
Middle Name:
Last Name:STOUT
Suffix:
Gender:F
Credentials:LCADC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 AVIGNON DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-1365
Mailing Address - Country:US
Mailing Address - Phone:201-478-1043
Mailing Address - Fax:
Practice Address - Street 1:55 AVIGNON DR
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-1365
Practice Address - Country:US
Practice Address - Phone:201-478-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00374900101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty