Healthcare Provider Details

I. General information

NPI: 1306936372
Provider Name (Legal Business Name): ELIZABETH M SCANLON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH MARY LACHAPELLE PHD

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S LUCILLE ST
BEVERLY HILLS FL
34465-4225
US

IV. Provider business mailing address

107 S LUCILLE ST
BEVERLY HILLS FL
34465-4225
US

V. Phone/Fax

Practice location:
  • Phone: 321-343-1175
  • Fax: 855-399-8331
Mailing address:
  • Phone: 321-343-1175
  • Fax: 855-399-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4999
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number891
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: