Provider Demographics
NPI:1215437090
Name:STOUT, MARTHA GIRLING (LICSW)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:GIRLING
Last Name:STOUT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2353
Mailing Address - Country:US
Mailing Address - Phone:978-356-5862
Mailing Address - Fax:
Practice Address - Street 1:78 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3324
Practice Address - Country:US
Practice Address - Phone:978-223-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-18
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10260861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical