MEDICARE: DR. ELIZABETH M SCANLON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4999	MA
2	103TC0700X	Clinical Psychologist	891	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1306936372	OTHER	NH	INDIVIDUAL NPI
2	1912079443	OTHER	NH	GROUP NPI
3	27210	OTHER	NH	PTAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0609214YONH02	OTHER		BCBS BHN NH VT MA CT

General Provider Information

NPI Number	:	1306936372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH M SCANLON PHD

Provider Business Mailing Address
First Line	:	107 S LUCILLE ST
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-4225
Country	:	US
Telephone Number	:	321-343-1175
Fax Number	:	855-399-8331

Provider Business Practice Location Address
First Line	:	107 S LUCILLE ST
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-4225
Country	:	US
Telephone Number	:	321-343-1175
Fax Number	:	855-399-8331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	03/12/2026

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