Provider Demographics
NPI:1386986388
Name:AHMAD-STOUT, DAVID J (PSYD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:AHMAD-STOUT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 WALNUT ST STE 1206
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4012
Mailing Address - Country:US
Mailing Address - Phone:410-802-8952
Mailing Address - Fax:215-821-8987
Practice Address - Street 1:1420 WALNUT ST STE 1206
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4012
Practice Address - Country:US
Practice Address - Phone:410-802-8952
Practice Address - Fax:215-821-8987
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty