Provider Demographics
NPI:1740318658
Name:SCANLAN, SEAN WYMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:WYMAN
Last Name:SCANLAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 AHA NIU PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1008
Mailing Address - Country:US
Mailing Address - Phone:808-277-7577
Mailing Address - Fax:808-356-1330
Practice Address - Street 1:1016 KAPAHULU AVE STE 265
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1318
Practice Address - Country:US
Practice Address - Phone:808-277-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-910103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical