Provider Demographics
NPI:1265663199
Name:SCULLY, ANNA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:B
Last Name:SCULLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HAWTHORN RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-9710
Mailing Address - Country:US
Mailing Address - Phone:310-413-9898
Mailing Address - Fax:
Practice Address - Street 1:22 HAWTHORN RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-9710
Practice Address - Country:US
Practice Address - Phone:310-413-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0107656103TC0700X
CAPSY 23728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical