Provider Demographics
NPI:1194447466
Name:SCANLON, ALYSE M (LICSW)
Entity type:Individual
Prefix:
First Name:ALYSE
Middle Name:M
Last Name:SCANLON
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451
Mailing Address - Country:US
Mailing Address - Phone:781-641-8500
Mailing Address - Fax:781-646-5172
Practice Address - Street 1:157 OVERLAND RD
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451
Practice Address - Country:US
Practice Address - Phone:978-528-7800
Practice Address - Fax:978-528-7810
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA126669104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker