Provider Demographics
NPI:1366118937
Name:STOUT, SARAH (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:STOUT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LEYDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01337-9740
Mailing Address - Country:US
Mailing Address - Phone:413-313-8285
Mailing Address - Fax:
Practice Address - Street 1:57 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6093
Practice Address - Country:US
Practice Address - Phone:802-254-0252
Practice Address - Fax:802-254-0253
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134939363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty