Provider Demographics
NPI:1194039602
Name:SCANNELL, JEFFREY M (MA, LMFT, ASAC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:SCANNELL
Suffix:
Gender:M
Credentials:MA, LMFT, ASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2421
Mailing Address - Country:US
Mailing Address - Phone:802-279-9407
Mailing Address - Fax:802-229-2508
Practice Address - Street 1:3 PITKIN CT
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-4509
Practice Address - Country:US
Practice Address - Phone:802-279-9407
Practice Address - Fax:802-229-2508
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTASAC101YA0400X
VT100.0045570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)