Provider Demographics
NPI:1437459245
Name:SCANLON, BRIAN ARTHUR (LADC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ARTHUR
Last Name:SCANLON
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 EASY ST
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:ME
Mailing Address - Zip Code:04924-3014
Mailing Address - Country:US
Mailing Address - Phone:207-474-9723
Mailing Address - Fax:
Practice Address - Street 1:460 EASY ST
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:ME
Practice Address - Zip Code:04924-3014
Practice Address - Country:US
Practice Address - Phone:207-474-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3847101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)