Provider Demographics
NPI:1891807533
Name:SCANLIN, ALISSA E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:E
Last Name:SCANLIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LOIS LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3057
Mailing Address - Country:US
Mailing Address - Phone:925-283-3902
Mailing Address - Fax:707-371-2433
Practice Address - Street 1:3468 MT DIABLO BLVD
Practice Address - Street 2:B203
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3957
Practice Address - Country:US
Practice Address - Phone:925-283-3902
Practice Address - Fax:707-371-2433
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20873103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist