Provider Demographics
NPI:1467465856
Name:SCANLON, JOAN PATRICIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:PATRICIA
Last Name:SCANLON
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 1:154 BROAD ST
Mailing Address - Street 2:STE 1512
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-3205
Mailing Address - Country:US
Mailing Address - Phone:603-881-7753
Mailing Address - Fax:978-339-5202
Practice Address - Street 1:154 BROAD ST
Practice Address - Street 2:STE 1512
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-3205
Practice Address - Country:US
Practice Address - Phone:603-881-7753
Practice Address - Fax:978-339-5202
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH331103G00000X, 103TC0700X
MA2356103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH061009Y0NH01OtherBHN
NHNH1009Medicare PIN