Provider Demographics
NPI:1093809030
Name:SCANLON, CAROL JUNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JUNE
Last Name:SCANLON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 HOLLY LANE
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342
Mailing Address - Country:US
Mailing Address - Phone:610-892-3800
Mailing Address - Fax:484-468-1412
Practice Address - Street 1:1204 HOLLY LANE
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342
Practice Address - Country:US
Practice Address - Phone:610-892-3800
Practice Address - Fax:484-468-1412
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0143891041C0700X
DEQ100006341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical