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General NPI Number Information
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NPI Number | 1689891699
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Entity Type | Individual
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Provider Name | CAROLYN JANE STOUTT MSW-ACSW
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 14600 RAMONA BLVD
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City | BALDWIN PARK
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State | CA
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Zip | 91706-3363
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Country | US
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Telephone | 626-337-8811
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Fax | 626-856-5653
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Provider Business Mailing Address
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Address Line | 6069 N OAKBANK DR
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City | AZUSA
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State | CA
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Zip | 91702-4141
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Country | US
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Telephone | 626-963-9578
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW19828
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License Number State | CA
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