Healthcare Provider Details

I. General information

NPI: 1578495248
Provider Name (Legal Business Name): CHRISTOPHER SCANLAN LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 WEST ST
FORT LEE NJ
07024-5028
US

IV. Provider business mailing address

500 E 77TH ST APT 1406
NEW YORK NY
10162-0016
US

V. Phone/Fax

Practice location:
  • Phone: 800-285-1584
  • Fax:
Mailing address:
  • Phone: 646-462-3972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00886100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: