Individual
DR. JEREMY WAYNE STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1207 BROAD ROCK BLVD, RICHMOND, VA 23249-1899
(804) 675-5000
Mailing address
269 LOOKOUT HILL RD, MILFORD, CT 06461-1899
(808) 375-4414
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY10800
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/31/2019
Last updated
04/04/2024
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