Individual
AMANDA STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
165 MAIN ST STE A, CORTLAND, NY 13045-3049
(607) 753-0234
Mailing address
165 MAIN ST STE A, CORTLAND, NY 13045-3049
(607) 753-0234
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
085550
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336163963
—
NY
Enumeration date
01/06/2009
Last updated
07/03/2018
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