Healthcare Provider Details

I. General information

NPI: 1366712010
Provider Name (Legal Business Name): ERIKA RAE SCANLON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMBRIDGE ST FL 14
BOSTON MA
02114-2509
US

IV. Provider business mailing address

47 OBERY ST
PLYMOUTH MA
02360-2229
US

V. Phone/Fax

Practice location:
  • Phone: 508-960-9242
  • Fax: 617-885-0158
Mailing address:
  • Phone: 508-746-8590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2270503
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2270503
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: