Provider Demographics
NPI:1851306377
Name:SCOLLAN, PAUL R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:R
Last Name:SCOLLAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6027
Mailing Address - Country:US
Mailing Address - Phone:203-238-7866
Mailing Address - Fax:203-468-3444
Practice Address - Street 1:595 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2934
Practice Address - Country:US
Practice Address - Phone:203-468-3297
Practice Address - Fax:203-468-3444
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical