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General NPI Number Information
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NPI Number | 1194039602
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Entity Type | Individual
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Provider Name | JEFFREY M. SCANNELL MA, LMFT, ASAC
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Gender | Male
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 3 PITKIN CT
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City | MONTPELIER
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State | VT
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Zip | 05602-4509
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Country | US
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Telephone | 802-279-9407
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Fax | 802-229-2508
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Provider Business Mailing Address
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Address Line | 70 LIBERTY ST
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City | MONTPELIER
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State | VT
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Zip | 05602-2421
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Country | US
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Telephone | 802-279-9407
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Fax | 802-229-2508
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ASAC
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 100.0045570
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License Number State | VT
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