Provider Demographics
NPI:1750143087
Name:SCANLAN, PATRICK
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:SCANLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 W 112TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1434
Mailing Address - Country:US
Mailing Address - Phone:904-563-5191
Mailing Address - Fax:
Practice Address - Street 1:4210 W 208TH ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-1545
Practice Address - Country:US
Practice Address - Phone:904-563-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health