Provider Demographics
NPI:1265794176
Name:SCANLON, JOANN
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:SCANLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:SCANLON
Other - Last Name:FIESEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS BCBA
Mailing Address - Street 1:18 HUBBELL ST
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2028
Mailing Address - Country:US
Mailing Address - Phone:631-499-1762
Mailing Address - Fax:
Practice Address - Street 1:125 E BETHPAGE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4228
Practice Address - Country:US
Practice Address - Phone:516-731-5588
Practice Address - Fax:516-577-9049
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-05-2224103K00000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist