Provider Demographics
NPI:1417271206
Name:SCANLON, RENEE L (LMSW, CASAC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:L
Last Name:SCANLON
Suffix:
Gender:F
Credentials:LMSW, CASAC
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:L
Other - Last Name:GANGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CASAC
Mailing Address - Street 1:913 CULVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7141
Mailing Address - Country:US
Mailing Address - Phone:585-654-5432
Mailing Address - Fax:585-288-7871
Practice Address - Street 1:913 CULVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7141
Practice Address - Country:US
Practice Address - Phone:585-654-5432
Practice Address - Fax:585-288-7871
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY82750104100000X
NY083895104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)