Provider Demographics
NPI:1538849369
Name:SCANLON, LISA (PRE-LICENSED CMHC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SCANLON
Suffix:
Gender:F
Credentials:PRE-LICENSED CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 HERRING BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-8201
Mailing Address - Country:US
Mailing Address - Phone:808-753-4219
Mailing Address - Fax:
Practice Address - Street 1:64 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3154
Practice Address - Country:US
Practice Address - Phone:808-753-4219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0134801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health