Healthcare Provider Details

I. General information

NPI: 1851306377
Provider Name (Legal Business Name): PAUL R. SCOLLAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 THOMPSON AVE
EAST HAVEN CT
06512-2934
US

IV. Provider business mailing address

465 E MAIN ST
MERIDEN CT
06450-6027
US

V. Phone/Fax

Practice location:
  • Phone: 203-468-3297
  • Fax: 203-468-3444
Mailing address:
  • Phone: 203-238-7866
  • Fax: 203-468-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000135
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: