Provider Demographics
NPI:1366691446
Name:SCANNELL, BEVERLEY (PSYD, CNS)
Entity Type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:
Last Name:SCANNELL
Suffix:
Gender:F
Credentials:PSYD, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MECHANIC ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-1690
Mailing Address - Country:US
Mailing Address - Phone:617-909-1141
Mailing Address - Fax:
Practice Address - Street 1:139 MECHANIC ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-1690
Practice Address - Country:US
Practice Address - Phone:617-909-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA88100364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP33405Medicare UPIN