Provider Demographics
NPI:1982195954
Name:SCANLON, MELINA BETH (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:BETH
Last Name:SCANLON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9736 SUMMERWIND CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-9192
Mailing Address - Country:US
Mailing Address - Phone:859-444-0277
Mailing Address - Fax:
Practice Address - Street 1:9736 SUMMERWIND CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001-9192
Practice Address - Country:US
Practice Address - Phone:859-287-4177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2561751041C0700X
OHS.1800651101YM0800X
KY253469104100000X
OHS.1802440104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100787060Medicaid