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Individual
MS. JILL CANNON
Active
Individual
MS. JILL CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
R#019571
NY
103TA0400X
Addiction (Substance Use Disorder) Psychologist
0190571
NY
103TC0700X
Clinical Psychologist
0190571
NY
103TF0000X
Family Psychologist
0190571
NY
103TF0200X
Forensic Psychologist
0190571
NY
103TP2701X
Group Psychotherapy Psychologist
019571
NY
1041C0700X
Clinical Social Worker
Primary
0190571
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
135497
VALUE OPTIONS
—
01
—
140019057NY01
ANTHEM
—
Enumeration date
02/22/2006
Last updated
10/23/2009
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